Stress ulcer prophylaxis in critical illness: a Canadian survey

Shears, Melissa; Alhazzani, Waleed; Marshall, John C.; Muscedere, John; Hall, Richard; English, Shane; Dodek, Peter; Lauzier, François; Kanji, Salmaan; Duffett, Mark; Barletta, Jeffrey F.; Alshahrani, Mohammed; Arabi, Yaseen M.; Deane, Adam M.; Cook, Deborah J.

doi:10.1007/s12630-016-0612-3

Cited by 26 publications

(18 citation statements)

References 22 publications

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“…While there is variation in practice worldwide, several surveys showed that PPIs are the most frequently used agents in North America, Australia, and Europe, followed by H2RAs [540][541][542][543][544]. A recent meta-analysis including 19 RCTs (n = 2177) showed that PPIs were more effective than H2RAs in preventing clinically important GIbleeding (RR 0.39; 95% CI 0.21-0.71; p = 0.002; moderate quality), but led to a nonsignificant increase in pneumonia risk (RR 1.17; 95% CI 0.88-1.56; p=0.28; lowquality) [544] prior meta-analyses reached a similar conclusion [545,546].…”

Section: We Recommend Against Stress Ulcer Prophylaxis In Patients Wimentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Rhodes

Evans

Alhazzani

et al. 2017

Critical Care Medicine

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Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

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Section: We Recommend Against Stress Ulcer Prophylaxis In Patients Wimentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Rhodes

Evans

Alhazzani

et al. 2017

Critical Care Medicine

Self Cite

2,380

814

View full text Add to dashboard Cite

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“…Although the latter were the most commonly used drugs years ago, proton-pump inhibitors now predominate. 6,[43][44][45] Recently, systematic reviews have outnumbered new randomized trials addressing the possible benefits of acid suppression during critical illness. Table 2 summarizes the results of the most recent network meta-analysis, involving 57 trials.…”

Section: Possible Benefitsmentioning

confidence: 99%

Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients

2018

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“…Apart from pharmacologic approaches for stress ulcer prophylaxis (SUP), advances in the care of critically ill patients, such as optimal fluid resuscitation to maintain hemodynamic stability and thus improve splanchnic perfusion, and early provision of enteral nutrition (EN), may contribute to this observation [ 2 – 4 ]. Although recommended only in patients on mechanical ventilation or coagulopathy, patients with traumatic brain injury or major burns, or those with ≥ 2 risk factors [ 5 , 6 ], SUP is still being used in nearly 90% of ICU patients, despite lack of an accepted indication in the majority [ 7 – 9 ]. Furthermore, SUP is often continued in these patients until clinical improvement, or even after transfer to the general ward [ 1 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Stress ulcer prophylaxis in intensive care unit patients receiving enteral nutrition: a systematic review and meta-analysis

et al. 2018

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BackgroundPharmacologic stress ulcer prophylaxis (SUP) is recommended in critically ill patients with high risk of stress-related gastrointestinal (GI) bleeding. However, as to patients receiving enteral feeding, the preventive effect of SUP is not well-known. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of pharmacologic SUP in enterally fed patients on stress-related GI bleeding and other clinical outcomes.MethodsWe searched PubMed, Embase, and the Cochrane database from inception through 30 Sep 2017. Eligible trials were RCTs comparing pharmacologic SUP to either placebo or no prophylaxis in enterally fed patients in the ICU. Results were expressed as risk ratio (RR) and mean difference (MD) with accompanying 95% confidence interval (CI). Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored.ResultsSeven studies (n = 889 patients) were included. There was no statistically significant difference in GI bleeding (RR 0.80; 95% CI, 0.49 to 1.31, p = 0.37) between groups. This finding was confirmed by further subgroup analyses and sensitivity analysis. In addition, SUP had no effect on overall mortality (RR 1.21; 95% CI, 0.94 to 1.56, p = 0.14), Clostridium difficile infection (RR 0.89; 95% CI, 0.25 to 3.19, p = 0.86), length of stay in the ICU (MD 0.04 days; 95% CI, −0.79 to 0.87, p = 0.92), duration of mechanical ventilation (MD −0.38 days; 95% CI, −1.48 to 0.72, p = 0.50), but was associated with an increased risk of hospital-acquired pneumonia (RR 1.53; 95% CI, 1.04 to 2.27; p = 0.03).ConclusionsOur results suggested that in patients receiving enteral feeding, pharmacologic SUP is not beneficial and combined interventions may even increase the risk of nosocomial pneumonia.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1937-1) contains supplementary material, which is available to authorized users.

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Stress ulcer prophylaxis in critical illness: a Canadian survey

Cited by 26 publications

References 22 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients

Stress ulcer prophylaxis in intensive care unit patients receiving enteral nutrition: a systematic review and meta-analysis

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