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Abstract

IntroductionThere are numerous randomized, controlled trials and several meta-analyses evaluating drug therapy for stress ulcer prophylaxis [1]. While these publications have shown significant benefit with using prophylaxis, a number of issues still remain unresolved. For example, Cook et al. performed a meta-analysis of published and unpublished research, and they concluded that sucralfate might be as effective as pH-altering medication in preventing stress-induced bleeding, with a lower incidence of pneumonia and mortality [1]. In a subsequent multicenter, randomized trial involving 1200 patients, Cook et al. found a lower incidence of clinically important gastrointestinal bleeding with ranitidine compared with sucralfate (relative risk, 0.44; 95% confidence interval, 0.21-0.92; P = 0.02), with no differences in pneumonia or mortality [2].In contrast to the multiple, and often conflicting, studies of stress ulcer prophylaxis conducted in general medical and surgical populations, decisions concerning appropriate stress H2 = histamine-2; ICU = intensive care unit. AbstractIntroduction A number of issues concerning stress ulcer prophylaxis remain unresolved despite numerous randomized, controlled trials and several meta-analyses. The role of stress ulcer prophylaxis, particularly in trauma patients, is further complicated by the lack of trials utilizing clinically important bleeding as an endpoint. Given the lack of consensus regarding stress ulcer prophylaxis in trauma patients, prescribing practices at Level I trauma centers in the United States were assessed. Materials and methods A survey was developed that contained questions related to institutional prescribing and evaluation of stress ulcer prophylaxis. The survey was intended to delineate these practices at the 188 Level I trauma centers (at the time of the present survey) in the United States. Results One hundred and nineteen surveys were returned, yielding a response rate of 63%. Eighty-six percent stated that medications for stress ulcer prophylaxis are used in a vast majority of trauma patients admitted to the intensive care unit. Sixty-five percent stated that there is one preferred medication. For these institutions, histamine-2-blockers were the most popular at 71%. Thirty-nine percent stated that greater than 50% of patients remain on stress ulcer prophylaxis following discharge from the intensive care unit. Conclusion The lack of consensus with regards to appropriate stress ulcer prophylaxis is apparent in this survey of Level I trauma centers. For those institutions with a preferred agent, histamine-2-blockers were most common.

Outcomes of patients with traumatic brain injury after stress ulcer prophylaxis: a retrospective multicenter study

“…Notably, this population, often under-represented in literature, demonstrated a higher SUP utilization rate compared with previous studies, but a lower rate than others (75–95%). 11 16 19 H2RAs were predominantly prescribed (88%) over PPIs (12%), potentially due to cost-effectiveness and the associated lower risk of infections, aligning with findings reported in the literature. 5 21 Additionally, this study found a low incidence of CSGIBs (1%) in this high-risk patient population, which is consistent with the rate reported by Palm and colleagues of 0.7% in patients with TBI with enteral feeding and lower than the rate reported previously for general critically ill patients.…”

Assessment of Stress Ulcer Prophylaxis Pattern in the Intensive Care Unit Patients

“…In this study, drug selection for SUP was determined by the H2RA class and the PPI class was the second choice, which is consistent with survey findings among Canadian (2) and United States (23) prescribers. In contrast, results of the studies by Vazin et al (20) and Shahbazi et al (24) in Iran, by Horsa et al (7) in Ethiopia and by Chen et al (25) in the United States, revealed that intravenous pantoprazole was the most prescribed drug for SUP.…”

Re-evaluating the Inhibition of Stress Erosions (REVISE): a protocol for pilot randomized controlled trial

“…This is reflected in the recent North American cross-sectional observational study mentioned above where PPIs were administered intravenously in 46% of patient-days. 8 We therefore elected to evaluate intravenous PPI to ensure that all patients could receive prescribed doses each day. Furthermore, using only the intravenous route minimizes the possibility of administration errors or missed doses which are more likely when switching between intravenous to enteral routes.…”

“… 10 – 12 For instance, a 58-center Canadian and American observational study confirmed that PPIs are used for SUP in 70% of patients receiving SUP in the ICU. 8 This may reflect the lower risk of clinically important bleeding with PPIs over H2RAs. 13 , 14 …”