Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a
            prospective cohort study

Santos, Yuri de Albuquerque Pessoa dos; Younes-Ibrahim, Mauricio; Crozatti, Lucas Lonardoni; Raglione, Dante; Cardozo, Luis Carlos Maia; Besen, Bruno Adler Maccagnan Pinheiro; Taniguchi, Leandro Utino; Park, Marcelo; Mendes, Pedro Vitale

doi:10.5935/0103-507x.20200007

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…Так, 41% пострадавших получали блокаторы Н 2 -гистаминовых рецепторов (ранитидин, фамотидин), 28% -ингибиторы протонной помпы (омепразол, рабепразол, пантопразол, эзомепразол), у остальных 31% пациентов профилактическая антисекреторная терапия не проводилась. По данным многих аналитических исследований, частота использования ингибиторов протонной помпы для профилактики стресс-индуцированных кровотечений непрерывно растет во всем мире, что требует проведения новых исследований на более однородных группах пациентов [6][7][8].…”

Section: Introductionunclassified

On the prevention of gastrointestinal bleeding in burned patients treated with omeprazole

Zinoviev

Bukatkina

2022

Innovacionnaâ medicina Kubani

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Background: The incidence of gastrointestinal bleeding in patients with severe burns can reach up to 10%.Objective: Evaluation of the risk factors for gastrointestinal bleeding and of the effectiveness of stress ulcer prophylaxis in patients with severe burns receiving proton pump inhibitors.Material and methods: The study included the results of treatment of 270 patients with burns more than 10% of total body surface area (TBSA), in whom 13 potential risk factors for gastrointestinal bleeding were studied. All patients received omeprazole therapy with 40 mg № 1 intravenous or 20 mg № 2 orally. The data obtained were processed in Microsoft Office Excel 2007 and IBM SPSS 20.0.Results: Significant risk factors for gastrointestinal bleeding were hypotension requiring treatment with vasopressors (dopamine ≥ 10 μg/kg/min or norepinephrine ≥ 0.5 μg/kg/min) for 2 or more days (χ2 = 5.126; p = 0.024) and full thickness burns with more than 50% of total body surface area (χ2 = 7.031; p = 0.008). The incidence of gastrointestinal bleeding was 4%. These bleedings were hemodynamically insignificant; in all cases, acute ulcers were the cause for them. There were no recurrences of bleeding and no repeated endoscopy or surgical treatment was required. The developed bleeding did not have a significant effect on mortality.Conclusion: Using proton pump inhibitors minimizes the frequency and intensity of gastrointestinal bleeding and also prevents lifethreatening complications during their development. More complex prevention of stress ulceration is necessary for patients with full thickness burns more than 50% of TBSA which develop hypotension requiring long‑term vasopressor therapy.

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Section: Introductionunclassified

On the prevention of gastrointestinal bleeding in burned patients treated with omeprazole

Zinoviev

Bukatkina

2022

Innovacionnaâ medicina Kubani

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“…A number of guidelines have been published over the past years in an effort to optimally direct acid suppression use for preventing SRMD 15&18-20 . Yet, a considerable body of evidence has demonstrated suboptimal SUP practice worldwide, with adherence rates to guidelines ranging from 30-70% [21][22][23][24][25][26][27][28][29][30][31] . Studies from the Arab world have reported inappropriate and excessive use of SUP.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Current Practice of Stress Ulcer Prophylaxis in Patients Admitted to Intensive Care Units in the Gaza Strip- Palestine

Alagha¹,

Mabhouh

2022

Bulletin of Pharmaceutical Sciences. Assiut

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This study aimed at assessing the degree of adherence of Stress ulcer prophylaxis (SUP) practice to the American Society of Health-System Pharmacists (ASHP) guidelines in intensive care units (ICUs) at three hospitals in the Gaza Strip, Palestine. This was a prospective study that utilized chart review methodology for data collection. Four aspects of SUP practice were assessed: indication, dose, route of administration and duration. The study enrolled 442 ICU patients with a median (Interquartile range, IQR) age of 49.0 (36.6) years. More than half the patients (55.7%) were males. Coagulopathy was the most common major risk factor for stress ulcer, presented in 73 (16.5%) patients, while the use of corticosteroid therapy was the most common minor risk factor presented in 93 (21%) patients. SUP was administered to 426 (96.4%) patients, of which 86.9% received ranitidine and 13.1% received PPIs. Overall adherence and indication adherence rates to guidelines were 16.7% and 36.4%, respectively. Appropriate dose, route and duration of SUP were found in 63.6%, 68.2%, and 88.1% of the evaluated doses, respectively. Of the 426 patients prescribed SUP, 48 (11.3%) developed adverse effects. This study revealed suboptimal SUP practice in the investigated hospitals and the need to apply strategies to improve SUP use patterns.

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“…In fact, up to 40% of intensive care unit (ICU) patients are inappropriately discharged on SUP. [11][12][13][14][15] Implications of inappropriate SUP include increased cost, polypharmacy, and medication adverse events (eg, pneumonia, myocardial ischemia, and Clostridioides difficile infection (CDI), antimicrobial resistance development), highlighting the need for acid suppression stewardship. [16][17][18][19] Various interventions including education, multidisciplinary rounds, clinical practice guidelines, audit-and-feedback, and pharmacist-based strategies in both ICU and non-ICU settings have shown variable results in improving SUP use.…”

Section: Introductionmentioning

confidence: 99%

Impact of Stress Ulcer Prophylaxis Discontinuation Guidance in Mechanically Ventilated, Critically Ill Patients: A Pre-Post Cohort Study

et al. 2021

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Purpose: Recent data highlight unclear efficacy and potential negative sequelae of stress ulcer prophylaxis (SUP) in the intensive care unit (ICU). Minimizing SUP exposure has pertinent clinical and other implications. This study assessed medication use and clinical outcomes before and after implementation of a practice guideline promoting early discontinuation of SUP in mechanically ventilated ICU patients. Methods: Retrospective, single-center, pre-post cohort study within a medical ICU at a large, academic medical center. Adult patients requiring mechanical ventilation and receiving SUP via a histamine-2 receptor antagonist (H2RA) or proton pump inhibitor (PPI) were eligible for inclusion. The clinical practice guideline was implemented on January 1, 2020. The impact of implementation was assessed via percent of patient-days with inappropriate SUP. Incidence of clinically important GI bleed was the primary safety outcome. Results: A total of 137 pre-guideline and 112 post-guideline patients were included. Comorbidity burden was similar between groups. A higher prevalence of baseline vasopressor receipt (39% vs 67%, P < .01) and acute kidney injury (56% vs 69%, P = .04) was observed in post-guideline patients. Post-guideline patients experienced a significantly lower percentage of patient-days of inappropriate SUP (25% vs 50%, P < .01) as well as higher rates of SUP discontinuation before extubation (71% vs 12%, P < .01) and during ICU stay (93% vs 50%, P < .01). Post-guideline patients observed a significantly lower incidence of SUP at hospital discharge (4% vs 35%, P < .01). No differences in bleeding outcomes were observed, though post-guideline patients experienced longer durations of mechanical ventilation, ICU stay, and hospital stay. Conclusions: Implementation of an early SUP discontinuation guideline was associated with significant improvements in SUP prescribing practices. Baseline differences between groups likely explain observed differences in clinical outcomes.

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Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study

Cited by 4 publications

References 36 publications

On the prevention of gastrointestinal bleeding in burned patients treated with omeprazole

On the prevention of gastrointestinal bleeding in burned patients treated with omeprazole

Evaluation of Current Practice of Stress Ulcer Prophylaxis in Patients Admitted to Intensive Care Units in the Gaza Strip- Palestine

Impact of Stress Ulcer Prophylaxis Discontinuation Guidance in Mechanically Ventilated, Critically Ill Patients: A Pre-Post Cohort Study

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