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Crit Care Resusc. 2014 Sep;16(3):170-4.

Opinions and practice of stress ulcer prophylaxis in Australian and New Zealand intensive care units.

Author information

1
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. glenn.eastwood@austin.org.au.
2
Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia.
3
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
4
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Melbourne, VIC, Australia.
5
Department of Intensive Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.
6
Medical Research Institute of New Zealand, Wellington, New Zealand.

Abstract

BACKGROUND:

Intensivists frequently prescribe proton pump inhibitors (PPIs) or histamine-2 receptor blockers (H2RBs) to intensive care unit patients for stress ulcer prophylaxis (SUP). Despite the common use of SUP medicines, there is limited high-level evidence to support the choice between them.

AIM:

To describe self-reported practice of SUP by Australian and New Zealand intensivists.

METHOD:

An online questionnaire of intensivists between 13 January and 3 February 2014.

RESULTS:

Seventy-two intensivists responded to the survey: 61 (85%) practised in public metropolitan ICUs and 13/48 (27%) practised in paediatric ICUs. Fifty-two (72%) respondents indicated that PPIs were their preferred SUP medicine. Respondents estimated that an average of 84% of ventilated and 53% of non-ventilated patients received SUP medicines during their ICU admission. Seven respondents (9%) were concerned or very concerned about the possible increased risk of upper gastrointestinal bleeding associated with H2RBs versus PPIs. Ten respondents (14%) were concerned or very concerned about the possible greater risk of Clostridium difficile infection, and 15 respondents (21%) were concerned or very concerned about the possible greater risk or ventilator-associated pneumonia with PPIs versus H2RBs. Most respondents (64 [89%]) agreed or strongly agreed that there was insufficient evidence to support the choice of an optimal SUP medicine, and 58 respondents (81%) agreed or strongly agreed to patient enrollment in an RCT comparing PPIs with H2RBs.

CONCLUSION:

Most survey respondents felt that current evidence is insufficient to justify the preferential use of PPIs or H2RBs for SUP and would enroll patients in a comparative SUP RCT.

PMID:
25161018
[Indexed for MEDLINE]

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