All patients received cefotaxime, steroids, and dvt prophylaxis. Options include the acidsuppressing drugs, ppi and h2ra, or the mucosaprotective agent sucralfate. If appropriate, discontinue sedation, and ensure that the patients head is 30 degrees above the bed. Additional criteria and specifications were used for class i articles from a tool. Uspstf strength of recommendation c the intervention is recommended selectively based upon professional judgment and patient preferences. No surveys of stress ulcer prophylaxis prescribing in the usa havebeen conducted since 1995. Ppis are more effective at keeping a constant gastric ph 4. It usually remains for five to seven days and heals within two weeks with no scarring. The incidence, pathophysiology, risk factors, diagnostic evaluation. Eligible studies were randomized controlled trials rcts in which. Conclusions and relevance among icu patients requiring mechanical ventilation, a strategy of stress ulcer prophylaxis with use of proton pump inhibitors vs histamine2 receptor blockers resulted in hospital mortality rates of 18. Stress ulcer prophylaxis in trauma patients article pdf available in critical care 66. The eastern association for the surgery of trauma east 916 views.
Background ppis are generally well tolerated and considered superior in the treatment of acidrelated conditions such as peptic ulcer disease. Despite widespread incorporation of stress ulcer prophylaxis into practice around the world, questions are emerging about its indications and impact. The aim of the supicu trial is to asses the overall benefits and harms of sup with proton pump inhibitor in adult critically ill patients in the icu. Stress ulcer prophylaxis is given to patient who is at high risk for developing this type of ulcer. The cost and economic effect of inappropriate stress ulcer prophylaxis has been assessed in two studies in critical care patients. The following list of medications are in some way related to, or used in the treatment of this condition. Sucralfate is a reasonable option and reduces the risk of stress ulcer related bleeding. A stress ulcer is a single or multiple mucosal defect which can become complicated by upper gastrointestinal bleeding or physiologic stress. Over the past 25 years, medications that reduce gastric acid or protect the stomach mucosa have been credited in lowering the risk of stress ulcerrelated bleeds from approximately 20% to 30%, to 2% to 14%. As a consequence, many critically ill patients require prophylaxis for primary prevention of bleeding from stress ulceration or treatment for stress ulcer related bleeding. Sucralfate is a reasonable option and reduces the risk of stress ulcerrelated bleeding. However, the quality of evidence supporting this has recently been questioned, and clinical equipoise exists. A systematic search of major electronic literature databases was conducted.
Whether there is overall benefit or harm of stress ulcer prophylaxis in adult hospitalised acutely ill patients is unknown. We suggest using ppis when stress ulcer prophylaxis is indicated in adult critically ill patients in the icu grade 2c. Guideline for stress ulcer prophylaxis in the intensive. A stress ulcer is not an exacerbation of duodenal ulceration by emotional stress, like that encountered during the coventry air raids in world war ii, nor is it. Gastrointestinal gi complications eg, gastric and intestinal motor dysfunction as well as stressrelated mucosal disease srmd frequently occur in these patients and adversely affect patient outcomes. Patients were considered highrisk with mean tryba risk score of 38.
Recent data suggest a decline in the incidence of bleeding caused by ulcer. Ashp therapeutic guidelines on stress ulcer prophylaxis pdf ashp therapeutic guidelines on stress ulcer prophylaxis pdf. Pdf stress ulcer prophylaxis in critically ill patients. Com 2 3 american society of health system pharmacists ashp. Stress ulcer prophylaxis is commonly administered to critically ill patients for the prevention of clinically important stressrelated mucosal bleeding from the upper gastrointestinal tract. Pdf to evaluate the current practice of stress ulcer prophylaxis sup in lebanese health care centers.
Stress ulcer prophylaxis litfl ccc gastroenterology. Pdf critically ill patients are at risk of developing stress ulcers in the upper digestive tract. Effect of stress ulcer prophylaxis with proton pump. To ensure safe evidence based utilization of stress ulcer prophylaxis to prevent upper. Stress ulcers are a known complication of a variety of critical illnesses. East practice management guidelines committee oscar d. Stress ulcer prophylaxis in the icu suhail sharif m. Pharmacists letter includes 12 issues every year, with brief articles about new meds and hot topics. Stress ulcer prophylaxis introduction the development of stress ulceration in the upper gastrointestinal gi tract has been part of critical care folklore since the beginning. Peptic ulcer disease peptic ulcer disease remains the most common cause of ugib, accounting for 21% to 40% of all bleeding epi sodes.
Sixtyseven highrisk patients were randomized toreceive either ranitidine 150 mg n 35 intravenouslydaily or. Survey of stress ulcer prophylaxis article pdf available in critical care london, england 36. As a consequence, many critically ill patients require prophylaxis for primary prevention of bleeding from stress ulceration or treatment for stress ulcerrelated bleeding. Three hundred sixtyeight surveys were sent to all members of thesection of pharmacy and pharmacology of the society.
Prevention of gastrointestinal bleeding in the icu. Since that time, the most comprehensive metaanalysisand largest randomized study to date concerning stress ulcer prophylaxis havebeen published. Histamine receptor blockers are now recommended as the preferred agent for stress ulcer prophylaxis in adults over proton pump inhibitors 6. List of stress ulcer prophylaxis medications 18 compared. Ashp therapeutic guidelines on stress ulcer prophylaxis. What is the appropriate duration for stress ulcer prophylaxis in this population.
Stress ulcer prophylaxis has historically been a disease process with a high degree of prevalence in the setting of burns and trauma. Ashp commission on therapeutics and approved by the ashp board of directors on november 14. On the other hand, they can potentially prevent a stress ulcer from forming in a critically ill patient. Stress ulcers are gastric mucosal erosions that can develop in patients with a serious illness or severe injury. Outcome measure of gi bleeding definition incidence clinically important gastrointestinalbleeding with spontaneous decrease in systolic blood pressure of more than 20 mmhg within 24 hours of the first gi episode. Stress ulcer prophylaxis in the intensive care unit full. The incidence of clinically important gastrointestinal bleeding due to stress ulceration has. Stress ulcer prophylaxis in the icu linkedin slideshare. Stress ulcer prophylaxis with ranitidine has been associated with an increased risk of ventilatorassociated pneumonia. Stress ulcer prophylaxis summary the incidence of clinically important gastrointestinal bleeding due to stress ulceration has declined with advances in the resuscitation and management of critically ill patients. Despite widespread incorporation of stress ulcer prophylaxis into practice around the world, questions are emerging about its indications and. Stress ulcer prophylaxis sup is standard of care in the intensive care unit icu, however the quantity and quality of evidence is low and potential harm has been reported.
Stress ulcer, gastritis, and gi bleeding prophylaxis in. Stress ulcer prophylaxis practice management guideline. Risks and benefits of stress ulcer prophylaxis in adult. Maintaining adequate systemic perfusion and initiating early enteral nutrition play a significant role in preventing stress ulceration.
Stress ulcer prophylaxis protects againstclinically important gastrointestinal bleeding and hasgained widespread use. In 1842 curling described a series of severe duodenal ulceration associated with burns. Stress ulcer prophylaxis is usually only used in hospitalized patients that are seriously ill and at high risk for stressrelated ulcers because of the risk of sideeffects such as pneumonia. If a stress ulcer prophylaxis is necessary, different options are available. We no longer need to stress ulcer prophylaxis in the critically ill. Prophylaxis against stress ulcers has been recommended for the prevention of ugi bleeding in critically ill adults patients. Stress ulcer prophylaxis introduction linkedin slideshare. H2 receptors antagonist widely use to critically ill patient as it is known to be effective in prevent stress ulcer from forming. Gastrointestinal prophylaxis in neurocritical care.
Assess the need for vte prophylaxis in patients admitted to the icu, and initiate an insulin infusion to maintain a blood glucose of 120 mgdl. To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units picus in porto alegre, brazil. Survey of stress ulcer prophylaxis critical care full text. Stress ulcer prophylaxis the term stress ulcer is somewhat of a misnomer because unlike peptic ulcers, these lesions are very superficial. Stress ulcer prophylaxis in the icu effects associated with the use of stress ulcer ashp is currently updating their guidelines, with. Antacids given to patient who is high risk for hemorrhage due to bleeding. Ordinary peptic ulcers are found commonly in the gastric antrum and the duodenum whereas stress ulcers are found commonly in fundic mucosa and can be located anywhere within the stomach and proximal duodenum. Stress ulcer prophylaxis is indicated for select patients grade level of quality moderate. Comparison of omeprazole and ranitidine for stress ulcer. Lukes boisemeridian medical centers disclosure statement no conflict of interest idaho society of health system pharmacists. Corrado blandizzi, carmelo scarpignato, in side effects of drugs annual, 2011. Action taken to prevent a stress ulcer, an ulcer of the duodenum in a patient with extensive superficial burns, intracranial lesions, or severe bodily injury.
Stress ulcer definition of stress ulcer by medical. This study compares the efficacyof omeprazole to ranitidine for this indication. This has led to nationwide disorganization in current practice a stress ulcer prophylaxis. Appropriateness of stress ulcer prophylaxis inhospitalized. Pathophysiology and prophylaxis of stress ulcer in. Neurocritical care patients are at high risk for stressrelated upper gastrointestinal ugi bleeding. The aim of this metaanalysis was to evaluate the risks and benefits of stress ulcer prophylaxis sup in this patient group. Stress ulcer prophylaxis in the intensive care unit. A medication use evaluation was performed to determine the appropriateness of stress ulcer prophylaxis for the veterans affairs va hospital in dayton, ohio. This was a multicenter, prospective, crosssectional observational study. Stress ulcerations are common in intensive care unit icu patients, some of which can cause hemorrhage. Although prophylaxis with h 2ras had no effect on pneumonia and hospital mortality overall, there was an increase in the incidence of hospitalacquired pneumonia and hospital mortality in the subgroup of patients that received stress.
Acid suppression therapy is commonly used for gastrointestinal gi prophylaxis in health systems. There is at least moderate certainty that the net benefit is small. Pdf 20080819 05 40 dw i program files common files ezb systems brings products into compliance with current and. Stress ulcer prophylaxis in pediatric intensive care units. Illinois masonic medical center uicmgh department of surgery slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Multiple risk factors have been associated with the. The primary cause of these ulcers is impaired blood flow, not gastric acidity crit care med 30. Picus were visited on randomly defined days between april 2006 and february 2007, and the medical records of admitted patients. Stress ulcer prophylaxis did not decrease the risk for gi bleeding in the patients that were fed enterally. Multiple protocols exist for prophylaxis of stress ulcer, but there are no universally accepted regiments. Outline jordan university of science and technology. Stress ulcer prophylaxis in the intensive care unit adult.
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