Melissa Shears1, Waleed Alhazzani2, John C Marshall3, John Muscedere4, Richard Hall5, Shane W English6, Peter M Dodek7, François Lauzier8, Salmaan Kanji9,10, Mark Duffett11, Jeffrey Barletta12, Mohammed Alshahrani13, Yaseen Arabi14, Adam Deane15, Deborah J Cook16. 1. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada. 2. Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada. 3. Department of Surgery, Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. 4. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. 5. Departments of Anesthesia and Critical Care Medicine, Dalhousie University, Halifax, NS, Canada. 6. Department of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 7. Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. 8. Departments of Medicine, Anesthesiology & Critical Care, Population Health and Optimal Health Practice Research Unit, CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada. 9. Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada. 10. Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada. 11. Department of Pediatrics, McMaster University, Hamilton, ON, Canada. 12. Department of Pharmacy Practice, Midwestern University, College of Pharmacy-Glendale, Glendale, AZ, USA. 13. Department of Emergency and Critical Care, King Fahad Hospital of the University of Dammam, Khobar, Saudi Arabia. 14. Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 15. Department of Intensive Care, University of Adelaide, Adelaide, Australia. 16. Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Health Sciences Center, Room 2C11, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada. debcook@mcmaster.ca.
Abstract
PURPOSE: Stress ulcer prophylaxis (SUP) using histamine-2-receptor antagonists has been a standard of care in intensive care units (ICUs) for four decades. Proton pump inhibitors (PPIs) are increasingly used despite apparently lower background rates of gastrointestinal bleeding and growing concerns about PPI-associated complications. Our objective was to understand the views and prescribing habits amongst Canadian physicians regarding SUP in the ICU and to gauge interest in a future randomized-controlled trial (RCT). METHODS: We created a short self-administered survey about SUP for critically ill adults, evaluated its clinical sensibility, and pilot tested the instrument. We surveyed all physician members of the Canadian Critical Care Trials Group (CCCTG) by e-mail and sent reminders three and five weeks later. RESULTS: We received 94 of 111 (85%) surveys from the validated respondent pool between May and June, 2015. Respondents reported use of SUP most commonly in patients 1) receiving invasive mechanical ventilation (62, 66%), 2) expected to be ventilated for ≥ two days (25, 27%), or 3) receiving mechanical ventilation but nil per os (NPO) (20, 21%). Stress ulcer prophylaxis is discontinued when patients no longer receive mechanical ventilation (75%), no longer are NPO (22%), or are discharged from the ICU (19%). Stress ulcer prophylaxis involves PPIs in 68% of centres. Most respondents endorsed the need for a large rigorous RCT of PPI vs placebo to understand the risks and benefits of this practice. CONCLUSIONS: Stress ulcer prophylaxis is reportedly used primarily for the duration of mechanical ventilation. The CCCTG physicians believe that a placebo-controlled RCT is needed to evaluate the effectiveness and safety of contemporary SUP with PPIs.
PURPOSE:Stress ulcer prophylaxis (SUP) using histamine-2-receptor antagonists has been a standard of care in intensive care units (ICUs) for four decades. Proton pump inhibitors (PPIs) are increasingly used despite apparently lower background rates of gastrointestinal bleeding and growing concerns about PPI-associated complications. Our objective was to understand the views and prescribing habits amongst Canadian physicians regarding SUP in the ICU and to gauge interest in a future randomized-controlled trial (RCT). METHODS: We created a short self-administered survey about SUP for critically ill adults, evaluated its clinical sensibility, and pilot tested the instrument. We surveyed all physician members of the Canadian Critical Care Trials Group (CCCTG) by e-mail and sent reminders three and five weeks later. RESULTS: We received 94 of 111 (85%) surveys from the validated respondent pool between May and June, 2015. Respondents reported use of SUP most commonly in patients 1) receiving invasive mechanical ventilation (62, 66%), 2) expected to be ventilated for ≥ two days (25, 27%), or 3) receiving mechanical ventilation but nil per os (NPO) (20, 21%). Stress ulcer prophylaxis is discontinued when patients no longer receive mechanical ventilation (75%), no longer are NPO (22%), or are discharged from the ICU (19%). Stress ulcer prophylaxis involves PPIs in 68% of centres. Most respondents endorsed the need for a large rigorous RCT of PPI vs placebo to understand the risks and benefits of this practice. CONCLUSIONS:Stress ulcer prophylaxis is reportedly used primarily for the duration of mechanical ventilation. The CCCTG physicians believe that a placebo-controlled RCT is needed to evaluate the effectiveness and safety of contemporary SUP with PPIs.
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Authors: Sean van Diepen; Tim Coulson; Xiaoming Wang; Dawn Opgenorth; Danny J Zuege; Jo Harris; Malik Agyemang; Daniel J Niven; Rinaldo Bellomo; Stephen E Wright; Paul J Young; Sean M Bagshaw Journal: Eur J Cardiothorac Surg Date: 2022-07-11 Impact factor: 4.534