Stressing over ulcer prophylaxis in the neurocritical trauma patient

Trauma Surg Acute Care Open, 2024 · DOI: 10.1136/tsaco-2024-001418 · Published: January 1, 2024

Simple Explanation

Critically ill patients, particularly those with traumatic brain injury (TBI) or spinal cord injury (SCI) are at high risk for stress ulcer formation. Treatment algorithms have been developed to guide stress ulcer prophylaxis (SUP), yet data regarding optimal agent, duration, and risks demonstrate conflicting results. McGraw and colleagues retrospectively evaluated outcomes in critically ill patients with TBI and SCI at six institutions in an attempt to elucidate optimal SUP treatment protocols.

Study Duration

Not specified

Participants

Critically ill patients with TBI or SCI

Evidence Level

Not specified

Key Findings

1
Those receiving SUP demonstrated longer hospital and intensive care stays.
2
Clinically significant gastrointestinal bleeding (CSGIB) was rare, occurring exclusively in patients with severe TBI (Glasgow Coma Scale <9), and with increased incidence in older patients.
3
SUP did reduce CSGIB for those with severe TBI.

Research Summary

The authors found that the majority of patients received SUP, generally with histamine receptor antagonists. Furthermore, there was no statistically significant difference between the rate of CSGIB with those receiving SUP versus those who did not, although a trend towards significance was noted. The authors add valuable data to the literature, and highlight the need for further study of SUP in neurocritical trauma patients, focusing on older patients and those with severe TBI.

Practical Implications

Targeted Prophylaxis

Stress ulcer prophylaxis should be carefully considered, particularly in older patients and those with severe TBI, as they appear to derive the most benefit.

Risk Stratification

The low incidence of CSGIB suggests a need for refined risk stratification to avoid unnecessary prophylaxis in lower-risk patients.

Further Research Needed

More research is needed to determine the optimal agent, duration of therapy, and the role of enteral feeding in preventing CSGIB.

Study Limitations

1
The authors were neither able to capture the duration or quantity of enteral feeding nor establish a causal relationship between SUP and pneumonia.
2
Thrombocytopenia, shock, and pre-existing liver disease may confound ulcer formation and should be further investigated.
3
The agent of choice and duration of therapy remain undefined.

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