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Fat-Soluble Vitamins
Published in Luke R. Bucci, Nutrition Applied to Injury Rehabilitation and Sports Medicine, 2020
Major trauma or burns was associated with large decreases of serum retinol levels to deficient ranges after 1 to 2 d postinjury.490–492 Incidence of gastric stress ulcers was associated with lowest serum vitamin A levels. As described previously, severe inflammation with corticosteroid release disturbs RBP synthesis, leading to decreased transport of retinol in plasma, and decreased plasma retinol levels with adequate liver stores. Massive parenteral doses of vitamin A (100,000 to 200,000 IU daily) were needed to bring plasma retinol levels into normal ranges.490,491 Prophylactic administration of high dose vitamin A decreased incidence of stress ulcers in two studies of severe trauma and burn patients by Chernov.490,491 Combined results from both studies found that 34/52 (65%) control patients developed stress ulcers, while 6/35 (17%) patients treated with retinol developed stress ulcers. Historical controls showed a 62% incidence of stress ulcers. However, soon after these findings were published, it became apparent that nutritional repletion with protein, zinc, and other nutrients (TPN) resulted in a smaller decrease in plasma retinol levels and prevented stress ulcers. Thus, administration of large doses of retinol were not necessary to correct a functional vitamin A deficiency in plasma.
Gastrointestinal bleeding
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Matthew R Banks, Peter D Fairclough
There appears to be a relationship between severity of illness and the risk of developing stress ulcers; however, the specific risk factors associated with stress ulcers include sepsis, multiple trauma, severe burns, severe hepatic dysfunction, renal failure and major operations. The probability of stress ulcer bleeding rises as the number of risk factors increases.
The digestive system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Prolonged physiologic stress can also lead to the formation of ulcers in the gastrointestinal tract. These “stress ulcers” may result from altered gastrointestinal blood flow and increased acid secretion. Patients at risk for the development of stress ulcers include those with severe trauma, sepsis, burn injury or respiratory distress syndrome. Cushing ulcers are a specific form of peptic ulcer seen in patients with brain injury. They are likely caused by excessive stimulation of the vagal nerve that enhances acid production and decreased blood flow to the gastric mucosa.
Stress-related upper gastrointestinal bleeding in adult neurocritical care patients: a Chinese multicenter, retrospective study
Published in Current Medical Research and Opinion, 2019
Junji Wei, Rongcai Jiang, Lihong Li, Dezhi Kang, Guodong Gao, Chao You, Jianmin Zhang, Liang Gao, Qibing Huang, Duanwu Luo, Gang Zhao, Hongyi Zhang, Shuo Wang, Renzhi Wang
Higher incidence of UGIB in critically ill neurosurgical patients was associated with risk factors such as GI ulcer or UGIB history, previous treatment with anticoagulants (blood thinners that delay blood clotting) or anti-platelets (drugs that keep blood clots from forming by preventing blood platelets from sticking together) (Tables 2 and 3), and mechanical ventilation for >48 hours. Although the incidence of stress GI bleeding in our study was not very high, the rates were higher than the estimated incidence; moreover, stress ulcers cannot be neglected because >50% of the patients develop mucosal damage within 24 hours of hospitalization, and have severe associated complications and high mortality rates3,5–8. This indicates stress ulcer becoming an alarming condition if untreated. Interestingly, the mnemonic FAST HUG (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control) described by Vincent et al. suggests that clinicians use SUP on a daily basis for improving the quality of care received by critically ill patients30.
Proton pump inhibitors: use and misuse in the clinical setting
Published in Expert Review of Clinical Pharmacology, 2018
Vincenzo Savarino, Elisa Marabotto, Patrizia Zentilin, Manuele Furnari, Giorgia Bodini, Costanza De Maria, Gaia Pellegatta, Claudia Coppo, Edoardo Savarino
Stress ulcer is an acute condition occurring in patients admitted in ICUs and is commonly located in the proximal stomach. It seems to be the result of an ischemic damage reducing the mucosal defense, thereby acid acts only as a secondary factor. Current guidelines approve the use of PPIs as stress ulcer prophylaxis (SUP) in ICU patients at high risk of GI bleeding, such as those who require mechanical ventilation for more than 48 h or those with coagulopathy, who have an OR of 15.6 and 4.3, respectively [73]. Several large meta-analyses found that the risk of bleeding in ICUs is reduced by about 60% in patients receiving SUP compared with those treated with placebo or no prophylaxis [74,75]. Therefore, SUP has become the standard of care in the ICUs, sometimes irrespective of the presence of risk factors.
Impact of a multifaceted intervention on non-guideline-recommended prescribing of acid suppressive medications for stress ulcer prophylaxis in critically ill patients
Published in Current Medical Research and Opinion, 2023
Furong Han, Chao Zhang, Tong Li, Zhihui Song, Shanshan Xu
Stress ulcer is a severe complication of critically ill patients, and its mechanism is related to the decrease of mucosal blood flow and the weakening of mucosal barrier function. Over 75% of critically ill patients develop stress ulcers within the first three days of ICU admission1,2. Severe stress ulcers can cause gastrointestinal (GI) bleeding3. The bleeding resulting from stress ulcers in critically ill patients increases the risk of death and length of intensive care unit (ICU) stay4. Therefore, stress ulcer prophylaxis (SUP) has become an essential part of the treatment of critically ill patients and is recommended by published guidelines to reduce the risk of ulcer-induced GI bleeding5.