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

• Published in: Critical care and resuscitation Vol. 16; no. 3; pp. 170 - 174
• Main Authors: Eastwood, Glenn M, Litton, Ed, Bellomo, Rinaldo, Bailey, Michael J, Festa, Mario, Beasley, Richard W, Young, Paul J
• Format: Journal Article
• Language: English
• Published: Australia 01-09-2014
• Subjects: Attitude of Health Personnel; Australia; Clostridium difficile; Critical Care; Data Collection; Enterocolitis, Pseudomembranous - chemically induced; Histamine H2 Antagonists - adverse effects; Histamine H2 Antagonists - therapeutic use; Humans; Intensive care units; Medicine, Preventive; Methodology; New Zealand; Peptic Ulcer - prevention & control; Physiological aspects; Pneumonia, Ventilator-Associated - etiology; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Psychological aspects; Science; Stress (Psychology); New Zealand; Australia
• ISSN: 1441-2772
• DOI: 10.1016/S1441-2772(23)01468-0

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 enrolment 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 enrol patients in a comparative SUP RCT.