Prevention of stress ulceration: Current trends in critical care

Ryan J. Daley, Jill A. Rebuck, Lynda S. Welage, Frederick B. Rogers

Research output: Contribution to journalReview articlepeer-review

127 Scopus citations

Abstract

Objective: To identify the level of current intensivist's knowledge regarding risk assessment and intensive care unit (ICU) clinical practice pertaining to stress-related mucosal bleeding, including pharmacologic approaches for stress ulcer prevention. Design: A nationwide survey of critical care physicians. Study Population: Two thousand random physician members of the Society of Critical Care Medicine. Measurements and Main Results: The response rate was 519 (26%) of 2000, with data analysis from 501 (25.1%) usable surveys. Respondents were affiliated with internal medicine (44.3%), surgery (42.3%), and anesthesiology (12.6%). Gut ischemia was indicated as the perceived major cause of stress ulceration (59.7%). The estimated incidence of clinically important bleeding was 2% or less by 62% of respondents; however, 28.6% of physicians surveyed initiate stress ulcer prophylaxis in all ICU patients, regardless of bleeding risk. Respiratory failure was most frequently indicated as a reason for stress ulcer prophylaxis (68.6%), followed by shock/hypotension (49.4%), sepsis (39.4%), and head injure/major neurologic insult (35.2%). The first-line agents selected for stress ulcer prophylaxis include histamine-2 receptor antagonists (63.9%), followed by proton pump inhibitors (23.1%), and sucralfate (12.2%). Concern for nosocomial pneumonia was regarded as more prevalent with antisecretory therapies in those who chose sucralfate (61%) as initial therapy compared with overall respondents (26.9%) (p < .001). Conclusions: The majority of intensivists surveyed recognize stress-related mucosal bleeding as a relatively infrequent event; however, implementation of a stress ulcer prophylaxis risk stratification scheme for ICU patients is necessary. Histamine-2 receptor antagonists are consistently perceived as appropriate initial agents, although proton pump inhibitors have become first-line therapy in an increasing percentage of critical care patients, despite limited data regarding their use in this population.

Original languageEnglish (US)
Pages (from-to)2008-2013
Number of pages6
JournalCritical care medicine
Volume32
Issue number10
DOIs
StatePublished - Oct 1 2004

Keywords

  • Acid suppression
  • Critical care
  • Gastrointestinal
  • Histamine antagonist
  • Proton pump inhibitor
  • Stress ulcer prophylaxis

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