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• W1567680096 abstract "Following the introduction of ‘ventilator care bundles’, which include stress ulcer prophylaxis but do not give any specific guidance, we decided to survey the use of agents prescribed for stress ulcer prophylaxis in ICUs in the UK. A total of 260 questionnaires were sent out and 198 (76%) responses received. Of these, 180 units (90%) stated that a protocol exists in their institution and 160 (81%) stated that stress ulcer prophylaxis was considered in all patients admitted to their ICU. For first line or standard stress ulcer prophylaxis sucralfate was used by 25 responders (13%), ranitidine by 131 (66%), nizatidine by two (1%), omeprazole 20 mg once daily by seven (3.5%), omeprazole 40 mg once daily by 15 (8%), lansoprazole 20 mg sublingual by four (2%), lansoprazole 30 mg orally by one (0.5%), lansoprazole 30 mg intravenously by two (1%), pantoprazole by 11 (5%) and combinations of drugs by 18 (9%). For high risk patients, sucralfate was used by six (3%), ranitidine by 25 (13%), omeprazole 20 mg once daily by nine (4.5%), omeprazole 40 mg once daily by 109 (55%), esomeprazole by one (0.5%), lansoprazole 30 mg intravenously by 16 (8%), pantoprazole by 32 (19%), and combinations of drugs by 30 (15%). Nosocomial or ventilator-associated pneumonia was not stated to be a factor in the choice of drug used by 119 of responders (60%), yet 13% of responders used sucralfate as first line prophylaxis and 3% used sucralfate in high risk groups. For standard prophylaxis, evidence-based medicine was stated as the reason for the choice of drug by 161 responders (81%). Trust or financial reasons were stated for the choice of drug by 30 (15%). For high risk patients, evidence-based medicine was stated as the reason for the choice of drug by 136 (69%), and Trust or financial reasons by 19 (10%). Evidence-based medicine is suggested as the reason for the choice of drug in 81% for first line prophylaxis compared with 69% in the high risk group. This is consistent with the literature suggesting that ranitidine is effective for stress ulcer prophylaxis in first line therapy but the evidence is less clear for high risk groups. There appears to be less certainty as to the reasons for the choice of drugs in the high risk group, with 18% providing no reason for their choice. Thirty-two responders (16%) stated that they would not stop prophylaxis when enteral feeding was established, and the rest would. This issue is controversial and continues to be investigated [1, 2]. A meta-analysis has suggested that there was strong evidence of reduced clinically important gastro-intestinal bleeding with H2 receptor antagonists and that sucralfate may be as effective in reducing bleeding as gastric pH altering drugs and is associated with lower rates of pneumonia and mortality [3]. A further study has observed a lower incidence of clinically important stress ulcers with ranitidine and a lower incidence of nosocomial pneumonia with sucralfate. Mortality and length of ICU stay were similar in both groups [4]. The use of intravenous proton pump inhibitors (PPIs) is now becoming widespread. There is preliminary work to suggest that PPIs are safe and effective for stress ulcer prophylaxis [5, 6]. Twenty per cent of responders used PPIs as first line prophylaxis in this study. These data show that application of the available evidence is not uniform. This is due to the data being inconclusive on all issues relating to stress ulcer prophylaxis. We believe that this uncertainty will remain." @default.
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• W1567680096 title "A survey of stress ulcer prophylaxis in Intensive Care Units in the UK" @default.
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• W1567680096 doi "https://doi.org/10.1111/j.1365-2044.2007.05050.x" @default.
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