Stress Ulcer Prophylaxis in the Intensive Care Unit

Mohebbi, Ladan; Hesch, Kristen

doi:10.1080/08998280.2009.11928562

Cited by 35 publications

(38 citation statements)

References 13 publications

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“…Also, enteral nutrition may be protective against formation of stress ulcers by leading to an increase in the gastric pH and providing protection from cytotoxins. 4,8,14 Tolerance of enteral nutrition in critically ill patients depends on adequate perfusion of the gut and suggests the absence of splanchnic ischemia. Palm et al evaluated Fig.…”

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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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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“…At the time the guideline was written, the authors note that there was insufficient data on PPIs to make any recommendations on their use, but no subsequent guidelines have been issued 30. Second, a review by Mohebbi and Hesch published in 2009, and a meta‐analysis by Lin and colleagues published in 2010, summarize subsequent randomized trials that suggest that PPIs and H2 blockers are, at best, similarly effective at preventing upper gastrointestinal (GI) bleeding among critically ill patients 31, 32. Third, the NICE guidelines do not include stress ulcer prophylaxis as an appropriate indication for PPIs except in the “prevention and treatment of NSAID [non‐steroidal anti‐inflammatory drug]‐associated ulcers.”19 Finally, H2RAs are currently the only medications with an FDA‐approved indication for stress ulcer prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Biofuel‐Cell Cathodes Based on Bilirubin Oxidase Immobilized through Organic Linkers on 3D Hierarchically Structured Carbon Electrodes

et al. 2014

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Different modification procedures to stabilize and control the orientation of Myrothecium verrucaria bilirubin oxidase (MvBOD) on 3D carbon nanotube/carbon microfiber‐modified graphite electrode surfaces were evaluated for the development of biofuel‐cell cathodes. The surface properties of different linkers for covalent binding of BOD were investigated by using atomic force microscopy‐based techniques. For all immobilization strategies, the maximal current response was obtained at a pH value of 6.5 with temperatures between 20 and 35 °C. The biocathode based on MvBOD immobilized through an imino bond to the electrode showed the highest current density (1600 μA cm−2) and was resistant to the presence of chloride ions. A biofuel cell was constructed, and it exhibited a maximal power of 54 μW cm−2 at 350 mV with an open‐circuit voltage of about 600 mV by using a cellobiose dehydrogenase based bioanode and glucose as the fuel.

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“…Over the past decades, the incidence of CSGIB has significantly declined [4]. In addition, the most widely used agents for SUP, proton pump inhibitors (PPI), have been associated with an increasing number of adverse effects, including myocardial infarction, Clostridium difficile infection, osteoporosis and ventilator associated Journal of Intensive and Critical Care ISSN 2471-8505 pneumonia [5]. As the incidence of CSGIB decreases and the knowledge about SUP-related adverse events increases, it is necessary to revisit the role of SUP in the ICU in current clinical practice.…”

Section: Reviewmentioning

confidence: 99%

“…Tolerance of enteral nutrition in the ICU is dependent on adequate gut perfusion, thereby demonstrating that the patient is not experiencing splanchnic ischemia. Furthermore, enteral nutrition may independently provide prophylaxis against stress gastropathy by increasing intragastric pH, similar to medication therapies, and providing cytotoxin protection [1,4,5]. A retrospective chart review evaluated the incidence of CSGIB in intubated surgical/trauma ICU patients tolerating enteral nutrition without pharmacological prophylaxis, finding no benefit to pharmacologic SUP [10].…”

Section: Reviewmentioning

confidence: 99%

We No Longer Need to Stress Ulcer Prophylaxis in the Critically Ill

Stepanski¹,

Palm²

2017

J Intensive Crit Care

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Preventing stress gastropathy has been a mainstay in the management of critically ill patients for decades. A landmark trial in 1994 identified the most significant risk factors for stress gastropathy as mechanical ventilation for greater than 48 h and primary coagulopathy. Since this study's publication more than two decades ago, the incidence of clinically significant gastrointestinal bleeding secondary to stress gastropathy has significantly declined. In addition, the most widely used agents for prophylaxis have been associated with an increasing number of adverse effects, including myocardial infarction, Clostridium difficile infection, osteoporosis, and ventilator associated pneumonia. As the incidence of significant bleeding decreases and the knowledge about prophylaxis-related adverse events increases, it is necessary to revisit current clinical practice. Major practice changes, including early aggressive fluid resuscitation and development of dynamic markers for volume status, have reduced the likelihood for prolonged hypoperfusion states. Additionally, the recognition of the important of enteral nutrition early in the ICU stay encourages mesenteric perfusion and reduces risk for development of ischemic damage. Contemporary studies have failed to replicate significant rates of gastrointestinal bleeding, likely in part due to these advances in care. Recent studies, including a pilot randomized trial, are questioning the necessity of pharmacologic prophylaxis in the modern era, with undetectable rates of gastrointestinal bleeding in enrolled patients. Patients with risk factors for stress gastropathy who demonstrate no evidence of splanchnic hypoperfusion may not benefit from receiving stress ulcer prophylaxis and tolerance of enteral nutrition may be used as a surrogate marker for adequate perfusion. Overall there is a lack of high quality data supporting stress ulcer prophylaxis in the modern era.

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Stress Ulcer Prophylaxis in the Intensive Care Unit

Cited by 35 publications

References 13 publications

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

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

Biofuel‐Cell Cathodes Based on Bilirubin Oxidase Immobilized through Organic Linkers on 3D Hierarchically Structured Carbon Electrodes

We No Longer Need to Stress Ulcer Prophylaxis in the Critically Ill

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