Prevention of stress ulceration: Current trends in critical care

Division of Trauma and Critical Care, University of Vermont, Burlington, Vermont, United States
Critical Care Medicine (Impact Factor: 6.31). 11/2004; 32(10):2008-13. DOI: 10.1097/01.CCM.0000142398.73762.20
Source: PubMed


To identify the level of current intensivist's knowledge regarding risk assessment and intensive care unit (ICU) clinical practice pertaining to stress-related mucosal bleeding, including pharmacologic approaches for stress ulcer prevention.
A nationwide survey of critical care physicians.
Two thousand random physician members of the Society of Critical Care Medicine.
The response rate was 519 (26%) of 2000, with data analysis from 501 (25.1%) usable surveys. Respondents were affiliated with internal medicine (44.3%), surgery (42.3%), and anesthesiology (12.6%). Gut ischemia was indicated as the perceived major cause of stress ulceration (59.7%). The estimated incidence of clinically important bleeding was 2% or less by 62% of respondents; however, 28.6% of physicians surveyed initiate stress ulcer prophylaxis in all ICU patients, regardless of bleeding risk. Respiratory failure was most frequently indicated as a reason for stress ulcer prophylaxis (68.6%), followed by shock/hypotension (49.4%), sepsis (39.4%), and head injury/major neurologic insult (35.2%). The first-line agents selected for stress ulcer prophylaxis include histamine-2 receptor antagonists (63.9%), followed by proton pump inhibitors (23.1%), and sucralfate (12.2%). Concern for nosocomial pneumonia was regarded as more prevalent with antisecretory therapies in those who chose sucralfate (61%) as initial therapy compared with overall respondents (26.9%) (p < .001).
The majority of intensivists surveyed recognize stress-related mucosal bleeding as a relatively infrequent event; however, implementation of a stress ulcer prophylaxis risk stratification scheme for ICU patients is necessary. Histamine-2 receptor antagonists are consistently perceived as appropriate initial agents, although proton pump inhibitors have become first-line therapy in an increasing percentage of critical care patients, despite limited data regarding their use in this population.

Full-text preview

Available from:
  • Source
    • "[3] In the same time period, the use of PPI for stress ulcer prophylaxis increased from 13% to 45%. Stress ulcer prophylaxis has been used unnecessarily in ICU patients without significant risk of bleeding [4] and some physicians even prescribe therapy in all ICU patients regardless of risk [5]. "

    Full-text · Article · Feb 2014
  • Source
    • "Jung and MacLaren suggested that PPIs are safe and efficacious for elevating intragastric pH in critically ill-patients for prevention of bleeding from stress-related mucosal damage.[19] 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.[20] "
    [Show abstract] [Hide abstract]
    ABSTRACT: The practice of emergency medicine has the primary mission of evaluating, managing and providing treatment to those patients with unexpected injury or illness. Instituting appropriate therapy is necessary for safety of the patients and to decrease mortality and morbidity. The objectives were to study the drug utilization pattern and direct cost of therapy in emergency medicine department of a tertiary care teaching hospital. Data of the patients admitted to emergency medicine department was collected prospectively for 48 h from the time of admission over 2 months. The prescriptions were analyzed for drug use pattern and direct cost of therapy was calculated. A total of 156 patients received 1635 drugs with the mean of 9.99 ± 2.55 drugs/patient. Most common diagnosis was acute coronary syndrome 35 (21.79%). Ondansetron 135 (86.53%) was most frequently prescribed drug followed by pantoprazole 133 (85.25%) and furosemide 68 (43.58%). Amongst antimicrobials ceftriaxone 51 (32.69%) was the most commonly prescribed drug. Direct cost of treatment per patient for the first 48 h was र 4051 ± 1641. Ondansetron and pantoprazole were the most commonly prescribed drugs in the emergency department. However, their use in all patients was not justified. Polypharmacy was prevalent. A closer look at the rationality of therapy would help in highlighting issues involved and would be helpful to authorities in deciding prescribing policies.
    Full-text · Article · Sep 2013
  • Source
    • "They also should define, for each patient admitted to intensive care, how to prevent upper GI bleeding related to “stress ulceration”. a now uncommon complication [3], but for which drug prophylaxis is widely used [4] and often involves proton pump inhibitors (PPIs) [4]. Because the latest international recommendations for the management of acute nonvariceal upper GI bleeding [2] or for GI bleeding related to portal hypertension [5] lack a specific approach to severe forms, and because the French consensus conference on prevention of “stress-related” upper GI bleeding in intensive care was nearly 25 years ago [6], we decided to draw up these recommendations (Table 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Intensivists are regularly confronted with the question of gastrointestinal bleeding. To date, the latest international recommendations regarding prevention and treatment for gastrointestinal bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of gastrointestinal bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Societe de Reanimation de Langue Francaise (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of gastrointestinal bleeding before endoscopic diagnosis, treatment of upper gastrointestinal bleeding unrelated to portal hypertension, treatment of upper gastrointestinal bleeding related to portal hypertension, management of presumed lower gastrointestinal bleeding, and prevention of upper gastrointestinal bleeding in intensive care.
    Full-text · Article · Nov 2012 · Annals of Intensive Care
Show more