Patterns of Use of Prophylaxis for Stress-Related Mucosal Disease in Patients Admitted to the Intensive Care Unit

Frandah, Wesam; Colmer-Hamood, Jane A.; Nugent, Kenneth; Raj, Rishi

doi:10.1177/0885066612453542

Cited by 20 publications

(25 citation statements)

References 35 publications

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“…Difficulties in identifying high‐risk patients may lead to this under‐ or overuse of SUP. In a US survey from 2012, 53% either received SUP without a clinical indication or did not receive SUP when indicated . Even though the evidence supporting the American Society of Health‐System Pharmacists criteria is modest, inappropriate use of SUP is common and overuse of SUP may be a more significant problem than underuse.…”

Section: Discussionmentioning

confidence: 99%

Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries

Krag

Perner

Wetterslev

et al. 2015

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries

Krag

Perner

Wetterslev

et al. 2015

Acta Anaesthesiol Scand

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“…Gastrointestinal (GI) stress ulcer are common in critically ill patients who require admission to Intensive Care Unit (ICU), whereas 75–100% of ICU patients experience mucosal injury as early as the first 24 h of ICU admission. [ 1 2 ] Moreover, occult bleeding occurs in 15–50% of critically ill patients and 5–25% of these patients experience overt bleeding if they do not receive stress ulcer prophylaxis (SUP). [ 3 ]…”

Section: Introductionmentioning

confidence: 99%

“…High morbidity and mortality of stress ulcer-related bleeding and concerns about cost and adverse effects of SUP administrations such as pneumonia and Clostridium difficile infections, provoked different studies to determine the pattern of SUP prescription in ICU and non-ICU patients. [ 2 3 4 5 6 7 8 9 10 11 12 13 ]…”

Section: Introductionmentioning

confidence: 99%

Adherence to stress-related mucosal damage prophylaxis guideline in patients admitted to the Intensive Care Unit

Rafinazari¹,

Abbasi²,

Farsaei³

et al. 2016

J Res Pharm Pract

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Objective:Concern about adverse effects of the inconsistent use of stress-related mucosal damage prophylaxis in intensive care unit (ICU) is increasing. Hence, this study was designed to prospectively evaluate the rate of inappropriate stress ulcer prophylaxis (SUP) administration upon ICU admission, at ICU discharge and determine the adherence to American Society of Health-System Pharmacists (ASHP) guideline during ICU stay.Methods:In this study, 200 patients were randomly selected from all ICU admissions during 9 months. Risk factors of stress ulcer were recorded daily during ICU stay and appropriateness of SUP administration was assessed according to the ASHP criteria.Findings:Of all 160 (80%) patients who received SUP, 44.4% did not have indication; and among 95 patients with an indication for SUP administration, 6.3% did not receive it upon ICU admission. Consequently, 77 (38.5%) of 200 patients received inappropriate prophylaxis on ICU admission. In addition, 53.5% of patients had appropriate adherence to ASHP guideline during all days of ICU stay (44% and 2.5% of patients received SUP more than 120% and <80% of appropriate SUP duration, respectively). Moreover, 81.2% were continued on inappropriate prophylaxis upon transfer from the ICU.Conclusion:We concluded that although SUP administration included both overutilization and underutilization in this ICU, but high prevalence of SUP overutilization caused unnecessary hospital costs, personal monetary burden, and may increase adverse drug reactions. Therefore, educating physicians and cooperation of clinical pharmacists regarding implementing standard protocols could improve patterns of SUP administration.

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“…The introduction of histamine‐2‐receptor antagonists (H2RAs) made intravenous administration possible, and a randomized clinical trial (RCT) in adult ICU patients reported a lower incidence of GI bleeding in patients receiving H2RA compared with sucralfate . Proton pump inhibitors (PPIs) were introduced later on, and today the majority of prescribed SUP for patients in all ages is H2RAs or PPIs …”

Section: Introductionmentioning

confidence: 99%

Stress ulcer prophylaxis in critically ill children: Protocol for a systematic review

Jensen

Marker

Quoc

et al. 2019

Acta Anaesthesiol Scand

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| Description of the conditionCritically ill children and adults are at risk of stress-related gastrointestinal (GI) mucosal damage. 1-3 This damage may progress into GI ulcerations, which in adults have been reported to increase morbidity and mortality. 4 Through the last 25 years the incidence of stressrelated GI ulcerations has dropped with present incidences in adult intensive care unit (ICU) patients in the area of 2%-5%. 5-7 The reported incidence of GI ulcerations in pediatric ICU (PICU) patients ranges from 0.4% to 5%, 1,8-11 with likely even higher incidences in neonatal ICUs (NICUs). 12 Suggested risk factors for the development of GI bleeding in the PICU and NICU include mechanical ventilation and coagulopathy. 8,10,12 Furthermore, a correlation between the severity of illness and upper GI bleeding events in children has been proposed. 13 | Description of the interventionIn order to prevent the potential progression from stress-related mucosal damage to GI bleeding, stress ulcer prophylaxis (SUP) was introduced more than four decades ago. 14 Initially, antacids and later sucralfate were the preferred agents. The introduction of histamine-2-receptor antagonists (H2RAs) made intravenous administration possible, and a randomized clinical trial (RCT) in adult ICU patients reported a lower incidence of GI bleeding

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Patterns of Use of Prophylaxis for Stress-Related Mucosal Disease in Patients Admitted to the Intensive Care Unit

Abstract: Stress ulcer prophylaxis administration in this ICU is inconsistent and includes both underutilization and overutilization. Educating physicians and implementing hospital protocols could improve use patterns.

Cited by 20 publications

References 35 publications

Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries

Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries

Adherence to stress-related mucosal damage prophylaxis guideline in patients admitted to the Intensive Care Unit

Stress ulcer prophylaxis in critically ill children: Protocol for a systematic review

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