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

Krag, Mette; Perner, Anders; Wetterslev, Jørn; Wise, Matthew Peter; Borthwick, Mark; Bendel, Stepani; McArthur, Colin; Cook, Deborah J.; Nielsen, Niklas; Pelosi, Paolo; Keus, Frederik; Guttormsen, Anne Berit; Møller, Anders; Møller, Morten Hylander

doi:10.1111/aas.12508

Cited by 90 publications

(76 citation statements)

References 38 publications

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“…While there is variation in practice worldwide, several surveys showed that PPIs are the most frequently used agents in North America, Australia, and Europe, followed by H2RAs [540][541][542][543][544]. A recent meta-analysis including 19 RCTs (n = 2177) showed that PPIs were more effective than H2RAs in preventing clinically important GI bleeding (RR 0.39; 95% CI 0.21-0.71; p = 0.002; moderate quality), but led to a nonsignificant increase in pneumonia risk (RR 1.17; 95% CI 0.88-1.56; p = 0.28; low quality) [544] prior meta-analyses reached a similar conclusion [545,546].…”

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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“…Other recent research shows a growing use of PPIs as the primary SUP agent, ranging from 39-70%. 6,9,10,12 This may reflect perceived superiority of PPIs as indicated in a recent systematic review and meta-analysis. The study at issue showed that PPIs were associated with a 60% relative risk reduction in clinically important stress ulcer-related GI bleeding when compared with H2RAs.…”

Section: Discussionmentioning

confidence: 99%

“…ICU = intensive care unit; NPO = nil per os; SUP = stress ulcer prophylaxis discontinue SUP upon discharge from the ICU, and only 13% discontinue SUP after tracheal extubation. 10 The prevailing impression of many physicians is that the clinically important GI bleeding rate has decreased over time in the ICU, whether due to prevalent acid suppression in the community and in the hospital setting or improvements in resuscitation and the use of enteral nutrition. Over 20 years ago, only 2% of critically ill patients had clinically important bleeding while receiving SUP.…”

Section: Discussionmentioning

confidence: 99%

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Stress ulcer prophylaxis in critical illness: a Canadian survey

Shears

Alhazzani

Marshall

et al. 2016

Can J Anesth/J Can Anesth

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“…Inclusion of non-ICU high-risk patients may also add to the questioned role of mechanical ventilation as a trigger of stress ulcers. Despite the clinical equipoise, common beliefs and practices across various medical specialties are that certain subpopulations of acutely ill patients benefit from stress ulcer prophylaxis [31]. …”

Section: Introductionmentioning

confidence: 99%

Stress ulcer prophylaxis versus placebo or no prophylaxis in adult hospitalised acutely ill patients—protocol for a systematic review with meta-analysis and trial sequential analysis

et al. 2017

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Background: Stress ulcer prophylaxis is considered standard of care in many critically ill patients in the intensive care unit (ICU). However, the quality of evidence supporting this has recently been questioned, and clinical equipoise exists. Whether there is overall benefit or harm of stress ulcer prophylaxis in adult hospitalised acutely ill patients is unknown. Accordingly, we aim to assess patient-important benefits and harms of stress ulcer prophylaxis versus placebo or no treatment in adult hospitalised acutely ill patients with high risk of gastrointestinal bleeding irrespective of hospital setting. Methods/design: We will conduct a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis and assess use of proton pump inhibitors (PPIs) or histamine-2-receptor antagonists (H2RAs) in any dose, formulation and duration. We will accept placebo or no prophylaxis as control interventions. The participants will be adult hospitalised acutely ill patients with high risk of gastrointestinal bleeding. We will systematically search the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS and Epistemonikos for relevant literature. We will follow the recommendations by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risk of systematic errors (bias) and random errors will be assessed, and the overall quality of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Discussion: There is a need for a high-quality systematic review to summarise the benefits and harms of stress ulcer prophylaxis in hospitalised patients to inform practice and future research. Although stress ulcer prophylaxis is used worldwide, no firm evidence for benefit or harm as compared to placebo or no treatments has been established. Critical illness is a continuum not limited to the ICU setting, which is why it is important to assess the benefits and harms of stress ulcer prophylaxis in a wider perspective than exclusively in ICU patients. Systematic review registration: PROSPERO CRD42017055676

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

Abstract: In this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.

Cited by 90 publications

References 38 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

Stress ulcer prophylaxis in critical illness: a Canadian survey

Stress ulcer prophylaxis versus placebo or no prophylaxis in adult hospitalised acutely ill patients—protocol for a systematic review with meta-analysis and trial sequential analysis

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