Stress-related mucosal damage. What to do or not to do.

SRMD and associated bleeding continue to challenge physicians caring for critically ill patients; however, the incidence of clinically significant bleeding appears to be decreasing. The reason for this decrease is multifactorial. Improved ICU support and early attention to patients' nutritional and metabolic needs have attenuated the pathogenic mechanisms leading to gastrointestinal mucosal injury. It remains to be seen whether future advances in critical care medicine, especially in the area of nutritional support and control of nosocomial infection, will completely obviate gastrointestinal complications. Until that time it is probably unwise entirely to abandon traditional SRMD prophylactic practices. For the present, clinicians should target treatment toward those individuals at highest risk for bleeding. Such a selective strategy is cost effective and provides the greatest clinical benefit.