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 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.

scholarly journals Implementation of Stress Ulcer Prophylaxis (SUP) in an Intensive Care Unit (ICU)

2019 ◽  
pp. 1-7
Author(s):  
Foroud Shahbazi ◽  
Hasanali Karimpur ◽  
Elham Hosseini
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Stress Ulcer ◽  
Tertiary Hospital ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Bleeding ◽  
Cross Sectional ◽  
Ulcer Prophylaxis

Background: Critically ill patients are at high risk for developing stress ulcer bleeding, which may increase the length of hospitalization and mortality rate. Stress ulcer prophylaxis could be done either with PPIs or with H2 receptor blockers, which were prescribed in critically ill patients. Aim: This cross-sectional study was accomplished in an intensive care unit to implement new stress ulcer prophylaxis.  Methods: This study was conducted in a tertiary hospital of Kermanshah province, west of Iran. Patients who were hospitalized for at least 72 hours and received SUP prophylaxis, were included in our study. Updated ASHP guideline was used for calculating SUP risk score. Patients received either PPIs or H2RA (intravenously or enteral). Efficacy and safety of early changes to enteral route were evaluated in one year and cost was calculated in three years’ period.  Results: This study was conducted on 150 patients with a mean age of 58 ± 18 years old. More than half of patients (53.3%) were male. Stress ulcer prophylaxis was prescribed for all critically ill patients, regardless of the risk of GI bleeding while only 76.6% of patients had an appropriate indication for receiving SUP protocol. Six patients in the PPIs group (4 in intravenous and 2 in enteral) experienced gastrointestinal bleeding. Changing the route of administration from intravenous to intravenous over a three-year period resulted in a decrease in the mean use of pentoprazole vials from 12 to 4 per patient. Conclusion: Early changing (within 72 hours) SUP from IV to enteral is safe and cost-saving approach.

scholarly journals Adequacy of stress ulcer prophylaxis prescription in the intensive care unit: an observational study

2020 ◽  
Author(s):  
Marilena Franchitti ◽  
Jitka Piubellini ◽  
Farshid Sadeghipour ◽  
Philippe Eckert ◽  
Pierre Voirol ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Prophylaxis

Stress ulcer prophylaxis in adult intensive care unit patients - a protocol for a systematic review

2018 ◽  
Vol 62 (6) ◽  
pp. 744-755 ◽  
Author(s):  
M. Barbateskovic ◽  
S. Marker ◽  
J. C. Jakobsen ◽  
M. Krag ◽  
A. Granholm ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Adult Intensive Care Unit ◽  
Ulcer Prophylaxis

Impact of Stress Ulcer Prophylaxis Algorithm Study

2005 ◽  
Vol 39 (5) ◽  
pp. 810-816 ◽  
Author(s):  
Christian J Coursol ◽  
Sabrina E Sanzari
Keyword(s):  
Intensive Care ◽  
Stress Ulcer ◽  
Treatment Algorithm ◽  
Intervention Group ◽  
Stress Ulcer Prophylaxis ◽  
Control Group ◽  
Post Intervention ◽  
Ulcer Prophylaxis ◽  
The Cost ◽  
The Impact

BACKGROUND: In the intensive care unit at Royal Victoria Hospital, we noted that drugs prescribed for stress ulcer prophylaxis were not always indicated or optimal. Accordingly, we implemented an algorithm for stress ulcer prophylaxis to guide the medical team in their decisions. The agents selected for the algorithm were intravenous famotidine and omeprazole suspension or tablets, depending on the available administration route. OBJECTIVE: To evaluate the impact of a treatment algorithm on the appropriateness of prescriptions for stress ulcer prophylaxis. METHODS: A quasi-experimental—type evaluative study was conducted based on a pre-/post-intervention design without a concurrent control group. A total of 555 complete admissions met the selection criteria; 303 patients formed the pre-intervention group, and 252 made up the post-intervention group (exposed to the treatment algorithm). RESULTS: After implementation of the algorithm, the proportion of inappropriate prophylaxis was decreased (95.7% vs 88.2%; p = 0.033). The number of days of inappropriate prophylaxis was also reduced significantly (p = 0.013), as was the cost per patient (p = 0.003) for all admissions. However, no difference was observed when the subgroup of patients who received prophylaxis alone was studied (p = 0.098 and p = 0.918). The presence of bleeding was similar in both groups. CONCLUSIONS: Introduction by pharmacists of a treatment algorithm for stress ulcer prophylaxis in intensive care units allows a reduction of inappropriate prescriptions and thus a reduction in the cost of drugs. The use of omeprazole suspension seems to be an alternative to intravenous histamine2-inhibitors; however, a large-scale study is necessary to confirm the efficacy and safety of proton-pump inhibitors administered by an enteral tube.

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