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عمومی::
خونریزی ناشی از استرس اولسر
Stress ulcer bleeding is an ominous development because these patients have been shown to have markedly higher mortality rates. fte classic finding on upper endoscopy is multiple areas of ulceration or petechial erosions, particularly in the gastric fundus; this entity cannot be treated endoscopically because diffuse bleed- ing arises from superficial mucosal capillaries. fte primary pre- vention of stress ulcer bleeding centers around decreasing acid production despite the fact that the pathophysiology suggests the mucosal changes drive this process.
Retrospective reviews have identified patients at high risk for stress ulcer bleeding, and
Various medications have been tried over the years to prevent stress ulcer bleeding, including anticholinergics and antacids, which had unwanted side effects and limited efficacy. fte intro- duction of cimetidine, the first histamine 2 (H2) receptor antago- nist, ushered in a new era in medicine that saw a dramatic reduction not only in stress ulcer bleeding but also in peptic ulcer disease. fte addition of sucralfate, an aluminum sulfate com- pound that functioned as a direct mucosal protection, offered additional therapeutic options, but this agent was cumbersome to use because medications and enteral feeding had to be held around its dosing several times a day.
A meta-analysis suggested that PPIs may be marginally more effec- tive than H2 receptor antagonists at reducing stress ulcer bleeding, but these benefits are likely offset by their significantly higher cost.
In contrast to stress ulcer bleeding events, VTEs are a frequent occurrence in the ICU, and surveillance studies of trauma patients found DVT rates of 50%.42 fte most significant consequence of VTE is pulmonary embolism (dis- cussed in detail in the Respiratory System), which can be fatal.
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