Raigmore Critical Care Guidelines Stress Ulcer Prophylaxis in

Raigmore Critical Care Guidelines Stress Ulcer Prophylaxis in Critical Care Aim To provide guidance on stress ulcer prophylaxis in critical care Scope All adult patients in Critical Care at risk of stress ulcers Stress Ulcers in Critical Care A superficial erosion in the gastric mucosa. ICU patients have multiple risk factors for development of stress ulceration. Prophylaxis should be considered in all ICU patients. Risk factors: mechanical ventilation > 48 hours hypotension prolonged NG tube placement chronic renal failure burns > 30% body surface area steroids coagulopathy sepsis acute hepatic failure severe head injury chronic alcohol use Patients who are not mechanically ventilated, are not coagulopathic, are enterally fed and have no major organ failure may not require prophylaxis. Discuss with the consultant before discontinuing treatment. Unit Policy: Early enteral feeding <12 hrs after admission. If large aspirates (>200 ml) consider continuing low volume 10 ml/hr enteral feeding. Consider establishing either TPN or post-pyloric feeding. • Initially Ranitidine 50 mg iv tds then consider enteral route 150 mg bd. Reduce dose in renal failure. • If deemed at high risk or already on PPI at time of admission consider lansoprazole Fasttabs 30 mg daily. • If concern re upper GI bleeding iv Omeprazole 80 mg iv over 1 hour followed by an iv infusion at 8 mg/hr for the next 72 hours. M Mac. Kinnon 23. 5. 2017