scholarly journals Current practice of stress ulcer prophylaxis in a surgical patient cohort in a German university hospital

2021 ◽  
Author(s):  
Julia Rauch ◽  
Maciej Patrzyk ◽  
Claus-Dieter Heidecke ◽  
Tobias Schulze
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Stress Ulcer ◽  
Demographic Data ◽  
Stress Ulcer Prophylaxis ◽  
University Hospital ◽  
Surgical Patients ◽  
Suppressive Therapy ◽  
Surgical Patient ◽  
Ulcer Prophylaxis

Abstract Introduction Stress ulcer prophylaxis (SUP) has been a widespread practice both in intensive care units (ICU) and internal wards at the beginning of the twenty-first century. Clinical data suggests an important overuse of acid suppressive therapy (AST) for this indication. Data on current clinical practice of SUP in surgical patients in a non-ICU setting are spares. In the light of a growing number of reports on serious side effects of AST, this study evaluates the use of AST for SUP in a normal surgical ward in a German university hospital. Methods Between January 2016 and June 2016, SUP was analysed retrospectively in 1132 consecutive patients of the Department of Surgery of the Universitätsmedizin Greifswald. Results The patients managed with and without SUP were similar with respect to demographic data and treatment with anticoagulants, SSRI and glucocorticoids. Patients with SUP were treated more frequently by cyclooxygenase inhibiting drugs (NSAID, COX2-inhibitors), were more frequently treated in the intermediated care unit and had a longer hospital stay. Risk factors for the development of stress ulcers were similarly present in patient groups managed with and without SUP. About 85.7–99.6% of patients were given SUP without an adequate risk for stress ulcer development, depending on the method used for risk assessment. Discussion Still today, SUP is widely overused in non-ICU surgical patients. Information campaigns on risk factors for stress ulcer development and standard operating procedures for SUP are required to limit potential side effects and increased treatment costs.

The Downward Spiral of Acid Suppressive Therapy in Stress Ulcer Prophylaxis

2017 ◽  
Vol 112 ◽  
pp. S621-S622
Author(s):  
Mirnouve Domond ◽  
Christopher Struby ◽  
Andrew Berson ◽  
Reena Bansal ◽  
Muhammad Sattar ◽  
...  
Keyword(s):  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Suppressive Therapy ◽  
Downward Spiral ◽  
Ulcer Prophylaxis

Acid Suppressive Therapy for Stress Ulcer Prophylaxis in Noncritically Ill Patients

2015 ◽  
Vol 49 (9) ◽  
pp. 1004-1008 ◽  
Author(s):  
Minh T. Hong ◽  
Leslie C. Monye ◽  
Charles F. Seifert
Keyword(s):  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Suppressive Therapy ◽  
Ulcer Prophylaxis

scholarly journals INTENSIVE CARE UNIT PRESCRIPTIONS MUST FIT RISK FACTORS TO PREVENT STRESS ULCER BLEEDING

2021 ◽  
Vol 34 (3) ◽  
Author(s):  
Rodolfo Castro Cesar de OLIVEIRA ◽  
Osvaldo MALAFAIA ◽  
Fernando Issamu TABUSHI ◽  
Carlos Roberto NAUFEL JUNIOR ◽  
Elora Sampaio LOURENCO ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Intensive Care ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Bleeding ◽  
Digestive Bleeding ◽  
Cord Injury ◽  
Ulcer Prophylaxis ◽  
Stress Ulcer Bleeding

ABSTRACT Background: The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. Aim: To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. Methods: Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. Results: One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). Conclusion: The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.

scholarly journals The SUP-ICU Trial: Does It Confirm or Condemn the Practice of Stress Ulcer Prophylaxis?

2019 ◽  
Vol 55 (2) ◽  
pp. 96-101 ◽  
Author(s):  
Jeffrey F. Barletta ◽  
Mitchell S. Buckley ◽  
Robert MacLaren
Keyword(s):  
Stress Ulcer ◽  
Controlled Trial ◽  
Infectious Complications ◽  
Stress Ulcer Prophylaxis ◽  
Suppressive Therapy ◽  
Secondary Outcome ◽  
Routine Practice ◽  
Risk Patients ◽  
Ulcer Prophylaxis ◽  
The Relationship

Purpose: Stress ulcer prophylaxis (SUP) is routinely administered to critically ill patients for the prevention of stress ulcer–induced, clinically important bleeding (CIB). Recently, the value of SUP has been questioned due to the perceived decline in CIB and the potential for infectious complications secondary to acid suppressive therapy. The SUP-ICU trial is a large, randomized controlled trial comparing intravenous pantoprazole with placebo for the indication of SUP. It is hoped that this trial would answer many of the questions pertaining to the overall value of SUP. This article will provide an in-depth assessment of the SUP-ICU trial in the context of the overall body of literature in this area. Furthermore, applications for clinical practice and recommendations on the provision of SUP are provided. Summary: The SUP-ICU trial revealed no difference in the primary outcome of 90-day mortality with pantoprazole but lower rates of CIB were noted (which was a secondary outcome). Overall, these data provide important insight into the value of SUP along with other questions related to the provision of SUP such as the relationship between CIB and mortality, infectious complications, and enteral nutrition. Conclusions: The SUP-ICU trial is a landmark trial describing the value of SUP in a modern-day setting of intensive care unit (ICU) practice. The provision of SUP should be continued in high-risk patients. Future studies are ongoing that will add further insight to this routine practice.

Evaluation of Continuation of Stress Ulcer Prophylaxis at Hospital Discharge

2009 ◽  
Vol 44 (10) ◽  
pp. 888-893 ◽  
Author(s):  
William R. Judd ◽  
George A. Davis ◽  
P. Shane Winstead ◽  
Douglas T. Steinke ◽  
Timothy M. Clifford ◽  
...  
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Hospital Admission ◽  
Drug Interactions ◽  
Stress Ulcer ◽  
Inappropriate Prescribing ◽  
Health Care Expenditures ◽  
Stress Ulcer Prophylaxis ◽  
Suppressive Therapy ◽  
Ulcer Prophylaxis

Purpose Stress-related mucosal disease (SRMD) can adversely affect patient morbidity and mortality. The use of stress ulcer prophylaxis (SUP) in patients with no risk factors for clinically important bleeding, however, is contributing to health care-related adverse events, drug interactions, and costs. The objective was to determine the percentage of hospitalized patients who receive SUP without an approved indication and to evaluate the financial impact of inappropriate prescribing as well as the risk for significant drug-drug interactions. Methods A retrospective chart review was performed of hospitalized adult cardiology, family medicine, and internal medicine patients between July 1, 2006 and June 30, 2007. Prescribing of acid suppressive therapy (AST) during hospital admission and indications for SUP were evaluated. Concomitant medications, cost of therapy, and discharge medications were assessed as secondary outcomes. Results Of the 4,603 patients admitted during the study period, 418 were randomly selected for study inclusion. Approximately 53% (221/418) of the selected patients received SUP during hospital admission, 93% (206/221) of whom had no indication for prophylaxis. Of those who continued AST at discharge (14%; 31/221), 84% (26/31) had no approved indication. Overuse of SUP resulted in 77 potential drug-drug interactions and an estimated 30-day outpatient cost of $37,950 for patients receiving these medications at discharge. Conclusion SUP is frequently prescribed to non–critically ill patients when the risk of SRMD is low. Use of SUP for patients who do not meet evidence-based criteria appears to contribute to increased health care expenditures, potential adverse events, and drug interactions.

scholarly journals Identifying Risk Factors Associated with Inappropriate Use of Acid Suppressive Therapy at a Community Hospital

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Amandeep Singh ◽  
Vijay Bodukam ◽  
Kirit Saigal ◽  
Jaya Bahl ◽  
Yvette Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stress Ulcer ◽  
Prescribing Patterns ◽  
Suppressive Therapy ◽  
Factors Associated ◽  
Inappropriate Use ◽  
Younger Age ◽  
Increased Risk ◽  
Ulcer Prophylaxis ◽  
Patient At Risk

Purpose. By examining the prescribing patterns and inappropriate use of acid suppressive therapy (AST) during hospitalization and at discharge we sought to identify the risk factors associated with such practices.Methods. In this retrospective observational study, inpatient records were reviewed from January 2011 to December 2013. Treatment with AST was considered appropriate if the patient had a known specific indication or met criteria for stress ulcer prophylaxis.Results. In 2011, out of 58 patients who were on AST on admission, 32 were newly started on it and 23 (72%) were inappropriate cases. In 2012, out of 97 patients on AST, 61 were newly started on it and 51 (84%) were inappropriate cases. In 2013, 99 patients were on AST, of which 48 were newly started on it and 36 (75%) were inappropriate cases. 19% of the patients inappropriately started on AST were discharged on it in three years. Younger age, female sex, and 1 or more handoffs between services were significantly associated with increased risk of inappropriate AST.Conclusion. Our findings reflect inappropriate prescription of AST which leads to increase in costs of care and unnecessarily puts the patient at risk for potential adverse events. The results of this study emphasize the importance of examining the patient’s need for AST at each level of care especially when the identified risk factors are present.

scholarly journals Evaluation of Stress Ulcer Prophylaxis Guideline in the Intensive Care Units of a Teaching Hospital: A Cross Sectional Study

2020 ◽  
Author(s):  
Afsaneh Vazin ◽  
Seyed Ruhollah Mousavinasab ◽  
Golnar Sabetian
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Stress Ulcer ◽  
Mucosal Damage ◽  
Stress Ulcer Prophylaxis ◽  
Major Risk Factor ◽  
Cross Sectional ◽  
Ulcer Prophylaxis

Background: One of the complications of critical ill patients admitted to intensive care unit (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis (SUP) should be administered to all critically ill patients with at least one major risk factor and two or more minor criteria. Methods: This study was performed during 6 months from October 2013 to December 2013 in Namazi Hospital intensive care units to assess the appropriate administration of SUP, according to American Society of Health-System Pharmacists (ASHP) protocol. Candidate for SUP according the ASHP guideline is considered if there is a at least one major risk factor or two or more minor risk factors. Results: Ninety-four patients were enrolled (46 men and 48 women). The mean age of study subjects was 51.5 years. The most major risk factor to stress ulcer found to be mechanical ventilation more than 48 hours (53%). The most minor risk factor for stress ulcer was ICU admission for less than one week (23.5%). Most prescribed medication for stress ulcer prophylaxis was intravenous Pantoprazole (44.7%). Our results have shown that about 74% patients were candidate for SUP according the ASHP guideline. 13(13.8%) of patients had only major risk factors. 5 (5.3%) of patients received SUP while they did not have at least one major risk factor or two or more minor risk factors. Conclusion: Our results have shown that 76.2% of the total SUP administrations were compliant with the ASHP guideline. Among the prescribed medication for SUP, intravenous pantoprazole had the highest percentage of administration (44.7%) and oral omeprazole had the lowest percentage of administration (7.4%). According to the results of our study, 72% of the route administrations are compliant with the ASHP guideline.

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