IS THE INCIDENCE OF HEMORRHAGIC STRESS ULCERATION IN SURGICAL CRITICALLY ILL PATIENTS AFFECTED BY MODERN ANTACID PROPHYLAXIS

Hemorrhagic stress ulceration (HSU), a known complication in the Surgi cal Intensive Care Unit (SICU) patient population, has a reported inci dence rate of 25 to 75 per cent. The goal of this study was to evaluat e whether the use of prophylactic antacid agents significantly reduced the frequency of HSU in critically ill patients, or whether improved care reflected the decrease in HSU. A total of 425 consecutive patient s were reviewed for occurrence of HSU; of these, 304 were eligible for the study. Admitting diagnoses were trauma including head injury, pos toperative patients, and patients with surgical complications. Inclusi on criteria were length of stay in the SICU for at least 48 hours; ant ral gastric pH subsequently measured every 6 to 8 hours and maintained at greater than or equal to 4; and absence of the history of peptic u lcer disease or gastrointestinal bleeding. One group included 251 (83% ) patients who were started on prophylactic agents (H-2 blockers with or without antacids); the second group of 53 (17%) patients had no pro phylaxis, The Injury Severity Score on admission to the SICU was 27.5 +/- 7.5, Apache II score was 26.4 +/- 6.4, and Revised Trauma Score wa s 4.3 +/- 2.3, with no difference in severity (P < 0.05). Thirteen (4% ) patients were found to have evidence of HSU: 11 of 251 (4%) in the f irst group and 2 of 53 (4%) in the second. No statistically significan t difference was found in the incidence of HSU between the two groups (P = 0.86). Results of this study suggest that modern prophylaxis for HSU did not significantly alter the incidence of stress ulceration in SICU patients.