Role of acid suppressants in intensive care medicine

Bleeding from stress-induced mucosal lesions continues to be a potential pr oblem in critically ill patients. although its incidence has decreased dram atically over the past decade. Patients considered to be at risk are those with respiratory failure, coagulopathy, severe burns or tetraplegia. The mo st important cause of stress ulcer bleeding is tissue hypoxia. Provided tha t appropriate dosage regimens are administered, all agents approved for str ess ulcer prophylaxis may reduce the incidence of overt as well as clinical ly important bleeding. However, the efficacy of stress ulcer prophylaxis do es not correlate with the efficacy of gastric acid inhibition. Although num erous studies have demonstrated that an alkaline gastric juice is associate d with gastric Gram-negative bacterial overgrowth, controversy remains over whether the pharmacological suppression of gastric acid in critically ill patients facilitates nosocomial pneumonia. The reasons for these divergent results are discussed, as is a possible association between gastric acid su ppression and other systemic infections. Finally, several cost-effectivenes s analyses performed over recent years have demonstrated that, in properly selected critically ill patients, stress ulcer prophylaxis is cost-effectiv e.