Disruption of this protective layer can occur in critically ill patients (eg, those with shock or sepsis) through overproduction of uremic toxins, increased reflux of bile salts, compromised blood flow, and increased stomach acidity through gastrin stimulation [mdedge.com]

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36:296-327. 4. Grube RR, May DB. Stress ulcer prophylaxis in hospitalized patients not in intensive care units. [reliasmedia.com]

Minor risk factors for development of stress ulcers include: Sepsis Trauma Acute organ failure Renal insufficiency Hepatic failure Thermal injury Lack of enteral feeding Prolonged ICU admission -- To view the remaining sections of this topic, please sign [anesth.unboundmedicine.com]

Respiratory failure (defined by mechanical ventilation 48h)* Coagulopathy ( INR  1.5 or platelets General (medical, surgical, respiratory) ICU populations Head injury (GCS 10) or inability to obey commands Thermal injury 35% BSA Hypotension Severe sepsis [accesspharmacy.mhmedical.com]

Chest. 2001 Apr; [PubMed PMID: 11296191] [8] Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012., Dellinger RP,Levy MM,Rhodes A,Annane D,Gerlach H,Opal SM,Sevransky JE,Sprung CL,Douglas IS,Jaeschke [statpearls.com]

Patients who do not fall into any of these groups have less than 0.5% risk of clinically significant bleeding and probably do not require prophylactic therapy. [revistagastroenterologiamexico.org]

There are numerous reasons that it’s nearly impossible to prove mortality benefit, including: Mortality rates are falling overall. Any signal of cause-specific mortality is easily lost within the noise of all-cause mortality. [emcrit.org]

With intragastric pH monitoring, studies in health have demonstrated that 70 % of patients have an intragastric pH 4 in the first 24 hours of ranitidine intravenous infusion which falls to 26 % on the third day of continuous infusion [ 16 ]. [ncbi.nlm.nih.gov]

these conditions can cause a reduction in GI mucosal blood flow and lead to a collapse of defense mechanisms of GI mucosa [ 45, 46 ], thus resulting in stress-related ulcer and subsequent GI bleeding. [bmcgastroenterol.biomedcentral.com]

Distress Syndrome: A National Database Analysis. [statpearls.com]

Eur J Anaesthesiol 2016;33:488-521. [ Crossref ] [ PubMed ] Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. [jtd.amegroups.com]

Upper gastrointestinal bleeding was defined as any episode of hematemesis, melena, or hematochezia; aspiration of any volume of blood through a nasogastric (NG) tube; or drainage of bloody or coffee-ground stomach contents from an NG tube. 5,9 Upper gastrointestinal [scielo.br]

We predefined overt GI bleeding as evidence of hematemesis, melena, hematochezia, or coffee-grounds emesis or aspirate regardless of other clinical findings, clinically important GI bleeding was defined as evidence of GI bleeding plus any of the following [bmcgastroenterol.biomedcentral.com]

Hunner's ulcer one involving all layers of the bladder wall, seen in interstitial cystitis. hypertensive ischemic ulcer a manifestation of infarction of the skin due to arteriolar occlusion as part of a longstanding vascular disease, seen especially in [medical-dictionary.thefreedictionary.com]

Additionally, these patients also have decreased circulating platelets due to portal hypertension induced splenic sequestration and decreased thrombopoietin production yet are able to maintain platelet clotting function through up‐regulation of von Willebrand [shmabstracts.com]

Results from a single-center study comparing clevidipine (Cleveprex—Medicines Company) with nicardipine for intensive blood pressure control in patients with hemorrhagic stroke, with concurrent hypertension requiring continuous infusions of an antihypertensive [pharmacist.com]

[…] paper exist that addresses the topic of risk factors for stress ulcer formation: Non-critically ill medical patients with 2 or more of the following: respiratory failure, sepsis, heart failure, hepatic encephalopathy, jaundice, kidney failure, stroke, hypertension [en.wikipedia.org]

[…] excite 、 alert ; nervous 、 anxious Active HPA axis ② ① 17. 1 catabolize glycogen and fat ， 2 HR  ,BP  ， 3 redistribution of blood to ensure the supply of main organs. 4 dilate bronchi,oxygen supply Periphery effects: CA  defense 18. 1.organ ischemia 2.hypertension [slideshare.net]

100%, within hours of admission to the ICU. 4 Occult bleeding (guaiac positive stools) prevalence ranges from 15 to 50%. 5 Overt bleeding is seen between 5 and 25% of critically ill patients. 5–8 The incidence of clinically important bleeding (i.e. tachycardia [revistagastroenterologiamexico.org]

Minal clot 48. petechia 49. Treatment Strategy Patients who do not have one of the six major risk factors do not require treatment. [slideshare.net]

Minor risk factors for development of stress ulcers include: Sepsis Trauma Acute organ failure Renal insufficiency Hepatic failure Thermal injury Lack of enteral feeding Prolonged ICU admission -- To view the remaining sections of this topic, please sign [anesth.unboundmedicine.com]

insufficiency; may contribute to esophageal & GI ... [accesspharmacy.mhmedical.com]

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency. [scielo.isciii.es]

The relative indications include sepsis (core temperature 38.5 C or 15,000 or 3, and a positive blood culture), renal insufficiency (creatinine clearance rate 2.8mg/dL), hepatic impairment (bilirubin 8.8mg/dL, serum aspartate amino transferase 500 U/L [jpbsonline.org]

[…] allergy, drug side-effects and drug interactions (esp cimetidine) pneumonia (HAP and CAP) PPIs interstitial nephritis (rare — but PPIs are a major drug causes) Clostridium difficile enterocolitis (PPIs have dose-dependent relationship) GI upset and headaches [litfl.com]