Adherence to stress-related mucosal damage prophylaxis guideline in patients admitted to the Intensive Care Unit

Rafinazari, Niloofar; Abbasi, Saeed; Farsaei, Shadi; Mansourian, Marjan; Adibi, Peyman

doi:10.4103/2279-042x.185728

Cited by 11 publications

(7 citation statements)

References 28 publications

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“…In most of the medical records reviewed (97.6%), the patients were on peptic ulcer prophylaxis. This finding demonstrates an improvement on previous studies in ICUs, which reported 53e78% compliance with peptic ulcer prophylaxis in similar populations [35,37]. The results of this study are consistent with the Surviving Sepsis Campaign guidelines, which strongly recommend peptic ulcer prophylaxis in mechanically ventilated patients [38,39].…”

Section: Discussionsupporting

confidence: 88%

Ventilation bundle compliance in two Australian intensive care units: An observational study

Madhuvu

Endacott

Plummer

et al. 2021

Australian Critical Care

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Background: The ventilation bundle has been used in adult intensive care units to decrease harm and improve quality of care for mechanically ventilated patients. The ventilation bundle focuses on prevention of specific complications of mechanical ventilation; ventilator-associated pneumonia, sepsis, barotrauma, pulmonary oedema, pulmonary embolism, and acute respiratory distress syndrome. The Institute for Healthcare Improvement ventilation bundle consists of five structured evidence-based interventions: head of the bed elevation at 30e45 ; daily sedation interruptions and assessment of readiness to extubate; peptic ulcer prophylaxis; deep vein thrombosis prophylaxis; and daily oral care with chlorhexidine. Objectives: The objective of the study was to evaluate the use of the ventilation bundle in two intensive care units in Victoria, Australia. Methods: This is a 3-month prospective observational study in two intensive care units. Patient medical records were reviewed on days 3, 4, and 5 of mechanical ventilation using a prevalidated ventilation bundle checklist. Results: A total of 96 critically ill patients required mechanical ventilation for more than 2 d. Patients had a mean age of 64.50 y (standard deviation ¼ 14.89), with an Acute Physiology, Age, Chronic Health Evaluation (APACHE) III mean score of 79.27 (standard deviation ¼ 27.11). The mean ventilation bundle compliance rate was 88.3% on the three consecutive mechanical ventilation days (day 3 ¼ 79.4%, day 4 ¼ 91.1%, and day 5 ¼ 96.7%). There was a statistically significant difference in the mean APACHE III score between patients who had head of bed elevation and those without head of bed elevation, on days 3 (p ¼ <0.001) and 4 (p ¼ 0.007). Conclusion: The ventilation bundle elements were used in Australian intensive care units. The likelihood of having all ventilation bundle elements on day 3 was low if the patient's APACHE III score was high. However, the ventilation bundle compliance rate increased with mechanical ventilation days.

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Section: Discussionsupporting

confidence: 88%

Ventilation bundle compliance in two Australian intensive care units: An observational study

Madhuvu

Endacott

Plummer

et al. 2021

Australian Critical Care

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“…Recently, Rafinazari et al studied the use of SUP during ICU stay and found that 80% patients received SUP, in which 44.4% showed no indication according to the AHSP guidelines; while 6.3% did not receive SUP though it was indicated. 18 In 2015, Krag et al found that 73% ICU patients received SUP and 59% patients with clinically important GI bleed had received SUP prior to bleed. 13 Krag et al found that CSGIB was associated with use of SUP on day 1 but not with mechanical ventilation.…”

Section: Resultsmentioning

confidence: 99%

“…1 Rafinazari et al also reported that, in their study, 38.5% of patients did not receive appropriate SUP on ICU admission and 81.2% continued on inappropriate SUP upon transfer from ICU. 18 Wohlt et al reported that 394 patients met the eligibility criteria for SUP, 357 patients were prescribed SUP, and 80% continued SUP on transfer from ICU. 27 This also imposes an unnecessary financial burden and increases the cost of healthcare.…”

Section: Resultsmentioning

confidence: 99%

Audit on Practices of Stress Ulcer Prophylaxis in Intensive Care Unit Patients

Gupta

Bhalotra

Singh

2011

Indian Journal of Critical Care Medicine

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Background: This audit was aimed at studying current practices regarding the use of stress ulcer prophylaxis (SUP) in the Indian critical care setup, with the background aim of raising awareness regarding the use and indications of SUP in critically ill patients. Materials and methods: After registering the trial with the clinical trial registry, India, a structured audit questionnaire containing 26 questions pertaining to SUP was distributed through electronic media among clinicians working in the intensive care units (ICUs) across India. Responses obtained were statistically analyzed. Results: The questionnaire was sent to 550 clinicians. Only 197 responded, of whom 91.4% were anesthesiologists, 5.6% were physicians, and 3% were intensivists. The audit revealed that 33% respondents were unaware of the existing SUP guidelines and around 32% did not have protocols for SUP in their ICU. Sixty-nine percent of respondents felt that all ICU patients must receive SUP and 44.7% opined that it should be started on ICU arrival. Almost 94% knew that early enteral feeding is protective against stress ulceration. Only 24.9% responders agreed that there must be clear indications for SUP, and most of them were unaware of all the potential side effects. Once initiated, 43.7% respondents would stop prophylaxis when no indication was left, whereas 69 respondents would stop on ICU discharge. Conclusion: There is a lack of awareness regarding initiation, choice of agent, adverse effects as well as termination of SUP in ICU and guidelines for the same. Institutional protocols should be in place and steps need to be taken to prevent unwarranted use. ) 161 setup; and types of drugs used for SUP, their indications and adverse effects, role of enteral feeding, and the appropriate time for discontinuation of the drug (Annexure 1). A reminder mail was sent twice at an interval of 1 week and the responses were collected and analyzed.

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“…Bu amaçla farklı seçenekler olmakla birlikte, ideal strateji tartışmalıdır. En önemli stratejinin erken enteral beslenme olduğu vurgulanmakla birlikte, farmakolojik ajan olarak proton pompa inhibitörleri ya da H2 reseptör blokerleri en sık tercih edilen ajanlardır (16)(17)(18)(19)(20) .…”

Section: Sedation (Sedasyon)unclassified

FAST HUGS WITH ICU Efficacy in Intensive Care Patients

Zincircioğlu¹,

Yaman²,

Köse³

et al. 2020

Terh

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Yoğun bakım ünitelerinde hastaların takipleri sırasında tüm yaşamsal parametrelerin atlanmadan düzenle takip edilmesi için baş harflerin birleştirilmesi ile oluşturulan kısaltmalar kullanılmıştır. Amacımız kontrol parametrelerini gözden geçirerek "FAST HUGS WITH ICU" ile günlük takiplerde saptanabilecek olası eksikliklerin topluca değerlendirilmesidir. Yöntem: Bu çalışma, Sağlık Bilimleri Üniversitesi İzmir Tepecik EAH ve Suat Seren EAH'lerinde Anestezi Yoğun Bakım Ünitesi dışında takip edilen; 29'u üçüncü düzey ve 24'ü ikinci düzey yoğun bakım hastasının rastgele bir günlük takibi sırasında uygulanmıştır. Her bir kontrol parametresi takip eden hekim ile birlikte değerlendirilmiş ve belirlenen uygulama eksiklikleri kaydedilmiştir. Bulgular: Yaş ortalaması 65,53±14,71, ağırlık ortancası 75 kg (65-80)'di. Çalışmamızda özellikle yeterli kalori alımının sağlanamadığı, sedasyon, analjezi ve tromboproflaksi uygulamalarında tedavi eksiklikleri olduğu, 11 hastada günlük araştırmaların ve tedavi planlamasının kaydedilmediği, 16 hastada günlük medikal tedavilerin gözden geçirilmediği, hastaların hiçbirinde CAM-ICU skorlamasının yapılmadığı ve diğer tüm parametreler için de takiplerde ve uygulamalarda eksiklikler olduğu saptanmıştır. On iki foley sondalı hastada saatlik idrar takibi yapılmadığı, 4 hastada 4 haftadan uzun süredir NG uygulandığı ve PEG'e geçilmediği saptanmıştır. Hastaların enfeksiyon markırlarının takibinde eksikler olduğu kaydedilmiştir. Sonuç: Çalışmamızda, literatür ile uyumlu olarak günlük hasta takibinde önemli eksikliklerin yapılabileceğini gördük. Bu nimonik 15 parametrenin aynı anda değerlendirildiği ve deneyimli kullanıcıların elinde çok hızlı ve kolektif bir gözden geçirme sağlayan bir parametredir.

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Adherence to stress-related mucosal damage prophylaxis guideline in patients admitted to the Intensive Care Unit

Cited by 11 publications

References 28 publications

Ventilation bundle compliance in two Australian intensive care units: An observational study

Ventilation bundle compliance in two Australian intensive care units: An observational study

Audit on Practices of Stress Ulcer Prophylaxis in Intensive Care Unit Patients

FAST HUGS WITH ICU Efficacy in Intensive Care Patients

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