ICU Ed and Todd-Cast New/Old: Risk factors for Stress Ulcers and Transfusions in GIB
May 20, 2025
The hosts share insights on the risk factors for stress ulcers and gastrointestinal bleeding, emphasizing the unexpected role of steroids. They delve into the complexities of transfusion thresholds, highlighting a study that critiques traditional practices and suggests a restrictive approach may lower mortality rates. The conversation navigates the importance of individualized stress ulcer prophylaxis based on patient severity, prompting a reevaluation of existing protocols. A humorous start leads to serious discussions about improving outcomes in critically ill patients.
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Risk Factors for Stress Ulcers
- Severity of illness markers like PATCHE2 score and vasopressor use predict upper GI bleeding risk.
- Protective factors include proton pump inhibitors and enteral nutrition volume.
Enteral Nutrition Protects GI
- Enteral nutrition appears protective against stress ulcers by improving gut perfusion.
- PPIs add additional protective benefit beyond enteral feeding alone.
Steroids Not Clear GI Bleed Risk
- Steroids were not independently associated with increased risk of GI bleeding.
- This challenges common teaching about steroids increasing GI bleed risk in ICU patients.