Stress ulceration

Gastric pH needs to be >4 to prevent stress ulcer formation
- incidence of bleeding is 2-3%
- most common indication for stress ulcer prophylaxis is respiratory failure (followed by shock/hypotensions, sepsis and neurotrauma)

Agents used for prophylaxis are:
- H2 blockers
- sucralfate (higher incidence of bleeding compared to H2 blocker)
- PPIs

- H2 and PPIs are equally effective in stress ulcer prophylaxis and have no difference in nosocomial pneumonia

Sucralfate vs. Ranitidine:
- RCT performed NEJM 1998
- ranitidine has 50% decreased ulcer rate (1.7 vs 3.8%) compared to sucralfate
- does not significantly increase ventilator associated pneumonia rate (16 vs 19%)