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Stress Related Mucosal Injury (SRMI)
- As the length of stay for many of our critically ill patients continues to rise, it is important to think about some preventative therapies
- SRMI is the term used to describe gastric mucosal erosions that occur in the critically ill
- SRMI can be demonstrated in 75 - 100% of critically ill patients within 24 hours and can cause clinically apparent bleeding in up to 25%
- Independent risk factors for SRMI include mechanical ventilation, coagulopathy, and a prior history of gastritis or peptic ulcer disease
- Additional risk factors in our ED patient population include sepsis, hypotensive states, severe head injury, multisystem trauma, and renal failure
- Typically an H2 antagonist is provided (i.e. ranitidine or famotidine). Currently there is no evidence of superiority of PPIs over H2 antagonists in preventing SRMI
- Pearl: the best agent to give is probably sucralfate - there is a slightly higher incidence of bleeding compared to ranitidine; however, ranitidine is associated with a much higher incidence of nosocomial pneumonia. The risk and mortality associated with nosocomial pneumonia in these patients outweighs the minimal risk of major hemorrhage associated with SRMI