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Crit Care Resusc. 2014 Sep;16(3):158-63.

A multicentre feasibility study evaluating stress ulcer prophylaxis using hospital-based registry data.

Author information

1
Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia. paul.young@ccdhb.org.nz.
2
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
3
Medical Research Institute of New Zealand, Wellington, New Zealand.
4
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
5
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
6
Intensive Care Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
7
Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia.
8
Critical Care and Trauma Division, The George Institute for Global Health, Sydney, NSW, Australia.
9
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.

Abstract

BACKGROUND:

It is unclear whether histamine-2 receptor blockers (H2RBs) or proton pump inhibitors (PPIs) are preferred for stress ulcer prophylaxis (SUP) in intensive care unit patients. Suitably powered comparative effectiveness trials are warranted.

OBJECTIVE:

To establish the feasibility of collecting process-of-care and outcome data relevant to a proposed interventional trial of SUP using existing databases.

DESIGN, SETTING AND PARTICIPANTS:

A retrospective cohort study conducted in seven Australia and New Zealand tertiary ICUs, including all patients ≥18 years admitted between 1 January 2011 and 31 December 2012.

MAIN OUTCOME MEASURES:

Doses of dispensed PPIs and H2RBs, upper gastrointestinal bleeding events, upper respiratory tract colonisation with pathogenic bacteria, Clostridium difficile infections and inhospital mortality.

RESULTS:

All sites were able to contribute to the study and investigators reported that data were generally easy to obtain. A median dose/ICU of 477 g of PPIs (interquartile range [IQR], 430.5-865 g), and 408.5 g (IQR, 109-1630.2 g) of H2RBs, were dispensed over the 2 years of the study. The median proportion of patients/ICU with upper GI bleeding complicating admission was 1.4% (IQR, 0.3%-1.8%). Colonisation of the respiratory tract with gram-negative bacteria occurred in a median of 7.1% of patients/ICU (IQR, 6.3%-14.1%). Pseudomembranous colitis occurred in hospital in a median of 1.4% of patients (IQR, 0.9%-2%) and inhospital mortality was 10.6% (95% CI, 9.5%- 11.7%).

CONCLUSIONS:

It is feasible to use existing data sources to measure process-of-care and outcome data necessary for a registry-based interventional trial of SUP.

PMID:
25161016
[Indexed for MEDLINE]

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