Evaluation of Stress Ulcer Prophylaxis Guideline in the Intensive Care Units of a Teaching Hospital: A Cross Sectional Study

Abstract

Background: One of the complications of critical ill patients admitted to intensive care unit (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis (SUP) should be administered to all critically ill patients with at least one major risk factor and two or more minor criteria.
 Methods: This study was performed during 6 months from October 2013 to December 2013 in Namazi Hospital intensive care units to assess the appropriate administration of SUP, according to American Society of Health-System Pharmacists (ASHP) protocol. Candidate for SUP according the ASHP guideline is considered if there is a at least one major risk factor or two or more minor risk factors.
 Results: Ninety-four patients were enrolled (46 men and 48 women). The mean age of study subjects was 51.5 years. The most major risk factor to stress ulcer found to be mechanical ventilation more than 48 hours (53%). The most minor risk factor for stress ulcer was ICU admission for less than one week (23.5%). Most prescribed medication for stress ulcer prophylaxis was intravenous Pantoprazole (44.7%). Our results have shown that about 74% patients were candidate for SUP according the ASHP guideline. 13(13.8%) of patients had only major risk factors. 5 (5.3%) of patients received SUP while they did not have at least one major risk factor or two or more minor risk factors.
 Conclusion: Our results have shown that 76.2% of the total SUP administrations were compliant with the ASHP guideline. Among the prescribed medication for SUP, intravenous pantoprazole had the highest percentage of administration (44.7%) and oral omeprazole had the lowest percentage of administration (7.4%). According to the results of our study, 72% of the route administrations are compliant with the ASHP guideline.

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

“…According to minor risk factors, in the present study, using heparin with therapeutic dose, ICU admission lasting >1 week and glucocorticoid therapy were the most indications for SUP (20.6%,18.7% and 16.2% respectively). These results were, in agreement with Farsaei et al ( 1), Vazin et al (20) and Foroughinia et al (21) findings. Given that the methodology, applied guideline, and the setting of the studies were almost similar in, all of, these investigations and the difference in the priority of risk factors is small, it seems that physicians are familiar with risk factors.…”

“…Our results have shown the most major risk factor to stress ulcer prophylaxis was coagulopathy (49.3%), followed by mechanical ventilation for more than 48 hours (28%) and history of GI ulceration or GI bleeding during past year (22.7%). These findings were in line with the results of studies conducted by Horsa et al ( 7), Rafinazari et al ( 6), Farsaei et al (11) and Foroughinia et al (21) In other studies, mechanical ventilation for more than 48 hours was the primary major risk factor for SUP (5,20,22). SUP was the third symptom in all of the studies examined for a history of GI ulceration or GI bleeding in the previous year.…”

“…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. The use of H2RAs versus PPIs is a point of contention on SUP.…”