Risks and Benefits of Stress Ulcer Prophylaxis for Patients With Severe Sepsis*

Sasabuchi, Yusuke; Matsui, Hiroki; Lefor, Alan Kawarai; Fushimi, Kiyohide; Yasunaga, Hideo

doi:10.1097/ccm.0000000000001667

Cited by 43 publications

(36 citation statements)

References 34 publications

(29 reference statements)

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“…Moderate quality of evidence showed that prophylaxis with either H2RAs or PPIs reduced the risk of GI bleeding compared to no prophylaxis (RR 0.44; 95% CI 0.28-0.68; low quality of evidence showed a nonsignificant increase in pneumonia risk (RR 1.23; 95% CI 0.86-1.78) [538]. Recently, a large, retrospective cohort study examined the effect of stress ulcer prophylaxis in patients with sepsis and found no significant difference in the risk of C difficile infection compared to no prophylaxis [539] (ESM 13). The choice of prophylactic agent should depend on patients' characteristics, patients' values and preferences, and the local incidence of C. difficile infections and pneumonia.…”

Section: S Stress Ulcer Prophylaxismentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: S Stress Ulcer Prophylaxismentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Moderate quality of evidence showed that prophylaxiswith either H2RAs or PPIs reduced the risk of GI bleedingcompared to no prophylaxis (RR 0.44; 95% CI 0.28-0.68; low quality of evidence showed a nonsignificant increase in pneumonia risk (RR 1.23; 95% CI 0.86-1.78) [538]. Recently, a large, retrospective cohort study examined the effect of stress ulcer prophylaxis in patients with sepsis and found nosignificant difference in the risk of C difficile infection compared to no prophylaxis [539] (ESM 13). The choice of prophylactic agent should depend on patients' characteristics, patients' values and preferences, and the local incidence of C. difficile infections and pneumonia.…”

Section: We Recommend Against Stress Ulcer Prophylaxis In Patients Wimentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Rhodes

Evans

Alhazzani

et al. 2017

Critical Care Medicine

2,344

814

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Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

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“…Stress ulcer prophylaxis has been associated with higher VAP rates in some observational studies and in a recent meta-analysis of randomized trials [92,123,124]. A large randomized trial of pantoprazole vs placebo, however, reported no difference between arms in pneumonia rates [125].…”

Section: In Intubated Patients Suspected Of Having Vap Should Distalmentioning

confidence: 99%

Ventilator-associated pneumonia in adults: a narrative review

Papazian¹,

2020

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Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections. Reported incidences vary widely from 5 to 40% depending on the setting and diagnostic criteria. VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated attributable mortality of VAP is around 10%, with higher mortality rates in surgical ICU patients and in patients with mid-range severity scores at admission. Microbiological confirmation of infection is strongly encouraged. Which sampling method to use is still a matter of controversy. Emerging microbiological tools will likely modify our routine approach to diagnosing and treating VAP in the next future. Prevention of VAP is based on minimizing the exposure to mechanical ventilation and encouraging early liberation. Bundles that combine multiple prevention strategies may improve outcomes, but large randomized trials are needed to confirm this. Treatment should be limited to 7 days in the vast majority of the cases. Patients should be reassessed daily to confirm ongoing suspicion of disease, antibiotics should be narrowed as soon as antibiotic susceptibility results are available, and clinicians should consider stopping antibiotics if cultures are negative.

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Risks and Benefits of Stress Ulcer Prophylaxis for Patients With Severe Sepsis*

Cited by 43 publications

References 34 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Ventilator-associated pneumonia in adults: a narrative review

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