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 Surgical Intensive Care Unit (SICU) patient population, has a reported incidence rate of 25 to 75 per cent. The goal of this study was to evaluate 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 patients were reviewed for occurrence of HSU; of these, 304 were eligible for the study. Admitting diagnoses were trauma including head injury, postoperative patients, and patients with surgical complications. Inclusion criteria were length of stay in the SICU for at least 48 hours; antral gastric pH subsequently measured every 6 to 8 hours and maintained at > or = 4; and absence of the history of peptic ulcer disease or gastrointestinal bleeding. One group included 251 (83%) patients who were started on prophylactic agents (H2 blockers with or without antacids); the second group of 53 (17%) patients had no prophylaxis. 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 was 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 first group and 2 of 53 (4%) in the second. No statistically significant 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.