UMEM Educational Pearls

Category: Critical Care

Title: SRMI ???

Keywords: stress related mucosal injury, histamine antagonists, proton pump inhibitors, sucralfate (PubMed Search)

Posted: 11/25/2008 by Mike Winters, MD (Updated: 10/22/2020)
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Stress Related Mucosal Injury (SRMI)

  • As the length of stay for many of our critically ill patients continues to rise, it is important to think about some preventative therapies
  • SRMI is the term used to describe gastric mucosal erosions that occur in the critically ill
  • SRMI can be demonstrated in 75 - 100% of critically ill patients within 24 hours and can cause clinically apparent bleeding in up to 25%
  • Independent risk factors for SRMI include mechanical ventilation, coagulopathy, and a prior history of gastritis or peptic ulcer disease
  • Additional risk factors in our ED patient population include sepsis, hypotensive states, severe head injury, multisystem trauma, and renal failure
  • Typically an H2 antagonist is provided (i.e. ranitidine or famotidine).  Currently there is no evidence of superiority of PPIs over H2 antagonists in preventing SRMI
  • Pearl:  the best agent to give is probably sucralfate - there is a slightly higher incidence of bleeding compared to ranitidine; however, ranitidine is associated with a much higher incidence of nosocomial pneumonia.  The risk and mortality associated with nosocomial pneumonia in these patients outweighs the minimal risk of major hemorrhage associated with SRMI