Gut

A nasogastric tube should be inserted to prevent gastric distension and decrease the risk of aspiration of gastric contents. Gastric residues should also be monitored regularly.

Stress ulceration occurs in critically ill patients but the incidence of associated gastrointestinal bleeding has decreased markedly, probably as a result of generally improved care. Maintaining adequate gastric blood flow can help to limit stress ulcer development. Gastric protective agents are routinely used to prevent stress ulceration, although there is no consensus on the best agent to use. By inhibiting gastric acidity, H 2 blockers may allow overgrowth of pathogenic bacteria from the gastrointestinal tract and thereby increase the risk of nosocomial pulmonary infection. In this respect, the use of barrier agents such as sucralfate may provide a better alternative, although these differences have been de-emphasized recently. The use of early enteral nutrition is important in maintaining gut function and limiting stress ulceration.

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