Prevention of stress ulceration: Current trends in critical care

Daley, Ryan J.; Rebuck, Jill A.; Welage, Lynda S.; Rogers, Frederick B.

doi:10.1097/01.ccm.0000142398.73762.20

Cited by 133 publications

(89 citation statements)

References 41 publications

(44 reference statements)

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“…Similarly, the small patient populations limit the results of comparative studies (PPIs vs placebo or H2-RAs) [30][31][32] . Data available indicate that PPIs are safe and efficacious for SUP [7,[32][33][34] .…”

Section: Data Collectionmentioning

confidence: 99%

“…Data available indicate that PPIs are safe and efficacious for SUP [7,[32][33][34] . However, PPIs should be used only as an alternative to H2-RAs or sucralfate pending further comparative studies with large sample size and pharmacoeconomic analysis [29][30][31][32][33][34] . As for misoprostol, the profile of side effects, drug interactions, lack of overall efficacy and availability of alternatives preclude its use in current medical practice [35] .…”

Section: Data Collectionmentioning

confidence: 99%

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Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

Zeitoun

Zeineddine²,

Dimassi³

2011

WJGPT

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AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers. METHODS:A multi-center prospective chart review study was conducted over 8 mo. A questionnaire was distributed to pharmacy students who collected data on demographics, SUP medications, dose, route, duration and associated risk factors. The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines. Institutional review board approval was obtained from each hospital center. RESULTS:A total of 1004 patients were included. 67% of the patients who received prophylaxis did not have an indication for SUP. The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications. Overall, the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample. This misuse was mainly observed in nonteaching hospitals. CONCLUSION:This study highlighted the need, in Lebanese hospitals, to establish clinical practice guidelines for the use of SUP; mainly in non-critical care settings.

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Section: Data Collectionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

Zeitoun

Zeineddine²,

Dimassi³

2011

WJGPT

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“…11 However, a study mentioned H2-receptor antagonists as appropriate initial agents, although PPIs have become first-line therapy in an increasing percentage of critical care patients, despite limited data regarding their use in this population. 12 Patanwala et al suggested that ondansetron may be used as a first-line agent for relief of nausea or vomiting for most patients in the emergency department. 13 Average number of drugs per prescription was 6.76 which is more than double the average number (Ideal 1.6-1.8) recommended by WHO.…”

Section: Discussionmentioning

confidence: 99%

Study of drug utilization pattern in emergency medicine ward at a tertiary care teaching hospital

Mamatha

Parashivamurthy

Suneetha

2017

Int J Basic Clin Pharmacol

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Background: The emergency department represents an important platform for conducting drug utilization studies as patients present with a wide spectrum of diseases in acute form. An irrational prescription adversely affects the prognosis and recovery of patients. Hence, the objective of our study was to evaluate the drug utilization pattern and to determine the rationality of prescription using WHO prescribing indicators in emergency medicine ward. Methods: After obtaining Institutional Ethical Committee approval, a prospective observational study was conducted over 2 months. The case records of 150 patients admitted to the emergency medicine ward, with a hospital stay of more than 24hrs were reviewed to analyze the prescription pattern during the initial 48hrs of admission. Case records of patients irrespective of age, sex and diagnosis were included in the study. Descriptive statistics were used to analyze the results (SPSS version 20).Results: A total of 1014 drugs were prescribed from 150 case records with a mean age of 47±18 years. An average of 6.76 drugs was prescribed per prescription; percentage of encounters with at least an antimicrobial was 115 (76.66%). Injections were prescribed in all patients (100%) and only 416 (41.02%) drugs were prescribed by generic name and 657 (64.79%) drugs abided to the WHO essential drug list. Majority of patients received antiulcerogenic drugs followed by antimicrobials. Conclusions: There was a tendency of polypharmacy with overuse of PPIs and antimicrobials. There is need to rationalize the drug therapy in terms of increasing prescription of drugs from essential drug list by generic name.

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“…There is, however, a disconnect between this awareness and the choice to administer prophylaxis, as shown by the fact that, even after correct identification of at-risk patients, some physicians recommend prophylaxis for all those admitted to intensive care. 2,19 In this study, ranitidine was the main drug used for SU In addition to being the first choice of medication for SU prophylaxis in the participating institutions, ranitidine was and is administered for long periods, usually for the duration of the patient's PICU stay, with no consideration given to stomach pH management or development of tolerance to the drug. 21 In all participating PICUs, use of prophylaxis was found to increase with the number of organ systems with altered function.…”

Section: Discussionmentioning

confidence: 99%

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Araújo¹,

Vieira²,

Carvalho³

2010

J. Pediatr. (Rio J.)

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Objective: To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units (PICUs) in Porto Alegre, Brazil.Methods: This was a multicenter, prospective, cross-sectional observational study. PICUs were visited on randomly defined days between April 2006 and February 2007, and the medical records of admitted patients were reviewed. Patients whose records had been previously assessed were excluded, as were those with upper gastrointestinal bleeding on admission. Data were collected on age, gender, admission diagnosis, severity of illness, administration of stress ulcer prophylaxis, rationale for prophylaxis, and first-line prophylactic agent of choice. Variables were described as absolute and relative frequencies, mean and standard deviation, or median and interquartile range as appropriate. Pearson's chi-square test for linear trend or Fisher's exact test were used to assess possible associations. The level of significance was set at 5% (p ≤ 0.05).Results: 398 patients (57% male) were assessed [median age, 16 months (IQR 4-65); median length of PICU stay, 4 days (IQR 1-9)]. Respiratory illness was the main reason for admission (32.7%). Most patients received stress ulcer prophylaxis (77.5%; range, 66-91%). Mechanical ventilation (22.3%) was the most common rationale provided, followed by informal routine use of prophylaxis (21.4%). Only one of the participating PICUs had a specific care protocol for use of stress ulcer prophylaxis. Ranitidine was the most commonly used drug (84.5% of cases). Evidence of minor gastrointestinal bleeding was found in 3% of patients; none had clinically significant bleeds. Conclusions:Administration of stress ulcer prophylaxis is a common practice in the participating PICUs, with ranitidine the most commonly used drug. Among the various rationales provided, mechanical ventilation and informal routine use were the most prevalent.J Pediatr (Rio J). 2010;86(6):525-530: Gastroduodenal ulcer, prophylaxis, children, intensive care, gastrointestinal bleeding.

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Prevention of stress ulceration: Current trends in critical care

Cited by 133 publications

References 41 publications

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

Study of drug utilization pattern in emergency medicine ward at a tertiary care teaching hospital

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

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