Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries

M Krag; A Perner; J Wetterslev; M P Wise; M Borthwick; S Bendel; C McArthur; D Cook; N Nielsen; P Pelosi; F Keus; A B Guttormsen; Alma D Moller; M H Møller; SUP-ICU Collaborators

doi:10.1111/aas.12508

Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries

M Krag, A Perner, J Wetterslev, M P Wise, M Borthwick, S Bendel, C McArthur, D Cook, N Nielsen, P Pelosi, F Keus, A B Guttormsen, Alma D Moller, M H Møller, SUP-ICU Collaborators

Department of Clinical Medicine

57 Citations (Scopus)

Abstract

BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries.

METHODS: Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects. Fisher's exact test was used to assess differences between groups.

RESULTS: Ninety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP agent, used in 66% of ICUs (64/97), and H2-receptor antagonists were used 31% (30/97) of the units. Twenty-three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP.

CONCLUSIONS: In this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	59
Issue number	5
Pages (from-to)	576-85
Number of pages	10
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.12508
Publication status	Published - 1 May 2015

Keywords

Anti-Ulcer Agents
Clostridium difficile
Critical Care
Cross Infection
Enterocolitis, Pseudomembranous
Health Care Surveys
Histamine H2 Antagonists
Humans
Intensive Care Units
Respiration, Artificial
Stomach Ulcer
Stress, Psychological

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10.1111/aas.12508

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Krag, M., Perner, A., Wetterslev, J., Wise, M. P., Borthwick, M., Bendel, S., McArthur, C., Cook, D., Nielsen, N., Pelosi, P., Keus, F., Guttormsen, A. B., Moller, A. D., Møller, M. H., & SUP-ICU Collaborators (2015). Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries. Acta Anaesthesiologica Scandinavica, 59(5), 576-85. https://doi.org/10.1111/aas.12508

Krag, M, Perner, A, Wetterslev, J, Wise, MP, Borthwick, M, Bendel, S, McArthur, C, Cook, D, Nielsen, N, Pelosi, P, Keus, F, Guttormsen, AB, Moller, AD, Møller, MH & SUP-ICU Collaborators 2015, 'Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries', Acta Anaesthesiologica Scandinavica, vol. 59, no. 5, pp. 576-85. https://doi.org/10.1111/aas.12508

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title = "Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries",

abstract = "BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries.METHODS: Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects. Fisher's exact test was used to assess differences between groups.RESULTS: Ninety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP agent, used in 66% of ICUs (64/97), and H2-receptor antagonists were used 31% (30/97) of the units. Twenty-three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP.CONCLUSIONS: In this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.",

keywords = "Anti-Ulcer Agents, Clostridium difficile, Critical Care, Cross Infection, Enterocolitis, Pseudomembranous, Health Care Surveys, Histamine H2 Antagonists, Humans, Intensive Care Units, Respiration, Artificial, Stomach Ulcer, Stress, Psychological",

author = "M Krag and A Perner and J Wetterslev and Wise, {M P} and M Borthwick and S Bendel and C McArthur and D Cook and N Nielsen and P Pelosi and F Keus and Guttormsen, {A B} and Moller, {Alma D} and M{\o}ller, {M H} and {SUP-ICU Collaborators}",

note = "{\textcopyright} 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",

year = "2015",

month = may,

day = "1",

doi = "10.1111/aas.12508",

language = "English",

volume = "59",

pages = "576--85",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

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number = "5",

}

TY - JOUR

T1 - Stress ulcer prophylaxis in the intensive care unit

T2 - an international survey of 97 units in 11 countries

AU - Krag, M

AU - Perner, A

AU - Wetterslev, J

AU - Wise, M P

AU - Borthwick, M

AU - Bendel, S

AU - McArthur, C

AU - Cook, D

AU - Nielsen, N

AU - Pelosi, P

AU - Keus, F

AU - Guttormsen, A B

AU - Moller, Alma D

AU - Møller, M H

AU - SUP-ICU Collaborators

PY - 2015/5/1

Y1 - 2015/5/1

N2 - BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries.METHODS: Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects. Fisher's exact test was used to assess differences between groups.RESULTS: Ninety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP agent, used in 66% of ICUs (64/97), and H2-receptor antagonists were used 31% (30/97) of the units. Twenty-three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP.CONCLUSIONS: In this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.

AB - BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries.METHODS: Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects. Fisher's exact test was used to assess differences between groups.RESULTS: Ninety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP agent, used in 66% of ICUs (64/97), and H2-receptor antagonists were used 31% (30/97) of the units. Twenty-three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP.CONCLUSIONS: In this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.

KW - Anti-Ulcer Agents

KW - Clostridium difficile

KW - Critical Care

KW - Cross Infection

KW - Enterocolitis, Pseudomembranous

KW - Health Care Surveys

KW - Histamine H2 Antagonists

KW - Humans

KW - Intensive Care Units

KW - Respiration, Artificial

KW - Stomach Ulcer

KW - Stress, Psychological

U2 - 10.1111/aas.12508

DO - 10.1111/aas.12508

M3 - Journal article

C2 - 25880349

SN - 0001-5172

VL - 59

SP - 576

EP - 585

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 5

ER -

Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries

Abstract

Keywords

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