A REVIEW OF STRESS-ULCER PROPHYLAXIS IN THE NEUROSURGICAL INTENSIVE-CARE UNIT

STRESS ULCERS OCCUR frequently in intensive care unit patients who hav e intracranial disease. After major physiological stress, endoscopic e vidence of mucosal lesions of the gastrointestinal tract appears withi n 24 hours of injury; 17% of these erosions progress to clinically sig nificant bleeding. Gastrointestinal hemorrhage has been associated wit h mortality rates of up to 50%. The pathogenesis of stress ulcers may not be completely understood, but gastric acid and pepsin appear to pl ay significant roles. Antacids, H-2 antagonists, and sucralfate are ef fective prophylactic agents in the medical/surgical intensive cave uni t. Appropriate therapy for neurosurgical patients remains unclear, how ever. This review summarizes the current literature regarding the path ogenesis and therapy of stress ulcers in neurosurgical patients.