Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Abstract

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.

Severe Potential Drug-Drug Interactions and the Increased Length of Stay of Children in Intensive Care Unit

“…Prescription of ranitidine or omeprazole is related to the stress ulcer prophylaxis protocol adopted by the PICU. In a prospective, cross-sectional, observational study in five PICUs in Porto Alegre, ranitidine was also the most commonly used drug for this prophylaxis (Araujo et al, 2010). National and international studies on adult critical care units indicated a variation of 44.3%-87.9% in the frequency of pDDIs observed (Hammes et al, 2008;Spriet et al, 2009;Reis and Cassiani, 2011).…”

Avaliação do perfil das intervenções realizadas pelo farmacêutico clínico e multidisciplinares após a implantação da metodologia FASTHUG em uma unidade de terapia intensiva

“…Of them, n=5 (3%) were performed by the clinical pharmacist. It is known that inappropriate use of drugs for stress ulcer prophylaxis and late changes in the administration route can be associated with potential adverse events, prolonged hospitalization times and higher costs, where a change in the administration route can effectively contribute to pharmacoeconomics and aim at ensuring that the medication will be administered via the recommended route 24,25 .…”

Need for a Randomized Controlled Trial of Stress Ulcer Prophylaxis in Critically Ill Children: A Canadian Survey

“…Nous avons envoyé par courriel de l'information sur l'étude, dont un lien menant au sondage en dix points, à 111 répondants potentiels et deux rappels à ceux n'ayant pas répondu d'emblée. Nous avons évalué, au moyen d'un modèle de régression logistique, les points de vue des répondants à propos de la nécessité d'un essai et de leur participation potentielle à celui-ci en fonction de leurs caractéristiques individuelles et, à l'aide d'un test de 2 , les différences régionales.…”

“…1 In a prospective observational study of 398 children from 5 PICUs in Brazil, 78% received prophylaxis. 2 There is currently insufficient evidence to assess the benefits of routine prophylaxis. The 3 published trials that have reported macroscopic or important bleeding (340 children in total) [3][4][5] found no difference between children receiving prophylaxis and those receiving no prophylaxis (relative risk 0.71, 95% confidence interval [CI] 0.42-1.19, p = 0.19).…”