Gastrointestinal prophylaxis in neurocritical care

Clemens M. Schirmer, Joshua Kornbluth, Carl B. Heilman, Anish Bhardwaj

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

The aim of this study is to review and summarize the relevant literature regarding pharmacologic and nonpharmacologic methods of prophylaxis against gastrointestinal (GI) stress ulceration, and upper gastrointestinal bleeding in critically ill patients. Stress ulcers are a known complication of a variety of critical illnesses. The literature regarding epidemiology and management of stress ulcers and complications thereof, is vast and mostly encompasses patients in medical and surgical intensive care units. This article aims to extrapolate meaningful data for use with apopulation of critically ill neurologic and neurosurgical patients in the neurological intensive care unit setting. Studies were identified from the cochrane central register of controlled trials and NLM PUBMED for english articles dealing with an adult population. We also scanned bibliographies of relevant studies. The results show that H2A, sucralfate, and PPI all reduce the incidence of UGIB in neurocritically ill patients, but H2A blockers may cause encephalopathy and interact with anticonvulsant drugs, and have been associated with higher rates of nosocomial pneumonias, but causation remains unproven and controversial. For these reasons, we advocate against routine use of H2A for GI prophylaxis in neurocritical patients. There is apaucity of high-level evidence studies that apply to the neurocritical care population. From this study, it is concluded that stress ulcer prophylaxis among critically ill neurologic and neurosurgical patients is important in preventing ulcer-related GI hemorrhage that contributes to both morbidity and mortality. Further, prospective trials are needed to elucidate which methods of prophylaxis are most appropriate and efficacious for specific illnesses in this population.

Original languageEnglish
Pages (from-to)184-193
Number of pages10
JournalNeurocritical Care
Volume16
Issue number1
DOIs
StatePublished - Feb 2012
Externally publishedYes

Fingerprint

Critical Illness
Ulcer
Nervous System
Intensive Care Units
Sucralfate
Population
Gastrointestinal Hemorrhage
Bibliography
Brain Diseases
Critical Care
Causality
Anticonvulsants
Pneumonia
Epidemiology
Hemorrhage
Morbidity
Mortality
Incidence

Keywords

  • Gastrointestinal
  • GI bleed
  • Neurocritical
  • Prophylaxis
  • Ulcer

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Gastrointestinal prophylaxis in neurocritical care. / Schirmer, Clemens M.; Kornbluth, Joshua; Heilman, Carl B.; Bhardwaj, Anish.

In: Neurocritical Care, Vol. 16, No. 1, 02.2012, p. 184-193.

Research output: Contribution to journalArticle

Schirmer, Clemens M. ; Kornbluth, Joshua ; Heilman, Carl B. ; Bhardwaj, Anish. / Gastrointestinal prophylaxis in neurocritical care. In: Neurocritical Care. 2012 ; Vol. 16, No. 1. pp. 184-193.
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