Stress ulcer prophylaxis: the case for a selective approach.

Although stress-related mucosal damage is common (and potentially serious) in critically ill patients, the risk of clinically significant gastrointestinal bleeding appears to be confined to patients with certain factors: mechanical ventilation, coagulopathy, multiple trauma, increased intracranial pressure, and multiorgan dysfunction. Because prophylactic therapy also poses risks, we advocate reserving it for patients in these high-risk groups.