OBJECTIVE: To describe current opinions about stress-related mucosal disease (SRMD) prevention in Canadian pediatric intensive care units (PICUs).
METHODS: A 22-question survey covering several aspects of SRMD was sent to all identified PICU attendings in Canada.
RESULTS: Sixty-eight percent of identified attendings completed the questionnaire. Thirty-eight percent were based in Quebec, 31% in Alberta, and 31% from other provinces. Most attendings (78%) had worked in a PICU for 6 years or more. When asked about risk factors for prescribing SRMD prevention drugs (more than 1 answer was accepted), the most popular answers were prior history of gastric ulceration/bleeding (33 respondents), coagulopathy (28 respondents), and major neurologic insult (18 respondents). Almost half of the attendings (48%) mentioned that they prescribe SRMD prophylaxis directly upon PICU admission to more than 25% of their patients. Forty-nine percent of respondents subjectively estimated that clinically significant upper gastrointestinal bleeding (UGIB; defined as UGIB associated with either hypotension, transfusion within 24 hours of the event, or death) occurred in less than 1% of their patients. Fifty-seven respondents (93%) used ranitidine as first-line therapy (average dose: 4.1 mg/kg/day, mainly intravenously). As second-line therapy, 32 attendings (52%) used pantoprazole and 13 (21%) used omeprazole.
CONCLUSIONS: Despite the paucity of guidelines on SRMD prevention and the low reported incidence of clinically significant UGIB, SRMD prevention is frequently used in Canadian PICUs. Ranitidine is the first-line drug used by most attendings.
L'honorable M. Gouin (Portneuf): Dans la présente affaire, l'important, c'est de connaître la vérité immédiatement. C'est ce que tout le monde demande. La meilleure politique à suivre serait de nommer le comité d'enquête qui
A 9-year-old boy presented to our outpatient specialized sport and exercise medicine clinic complaining of a subacute onset of unilateral knee pain, after an increased level of soccer training. His knee examination was unremarkable. However, he demonstrated significant tenderness on palpation of his ipsilateral hip flexor and adductor tendons. Abnormalities in muscle tone and difficulty in relaxing and resisting the examiner properly were noted and lead to a complete neurological examination. It demonstrated multiple abnormalities such as increased tone and deep tendon reflexes, greater in lower than upper extremities, and abnormal patterning. A mild form of spastic diplegia was suspected and the patient was referred to a pediatric neurologist who confirmed our initial diagnosis. This case draws attention to the importance of maintaining a high level of suspicion for milder forms of diseases that can go unnoticed for years.
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