Home Stress Ulcer Prophylaxis. Recommendations Stress Ulcer Prophylaxis is indicated for select patients Grade Level of Quality — moderate; USPSTF strength of recommendation — C [the intervention is recommended selectively based upon professional judgment and patient preferences.
Duration of Treatment Until risk factors resolve Background Gastrointestinal bleeding secondary to stress ulcer formation is a well-known complication of critical illness. Relevant Literature Search Overall, mostly low quality data regarding these topics exists begging the need for a large multi-center randomized trial to help clarify these questions. Level 1: No difference between H2 blocker, PPI, sucralfate Level 2: Sucralfate should not be used in patients on dialysis Level 3: Enteral feeding may be insufficient mono-prophylaxis.
Pantoprazole 40mg PO q24 hours cannot be crushed. Randomized Controlled Trial, 10 years, English language. Stress ulcer prophylaxis AND acid suppressing drugs. Impact of trauma stress ulcer prophylaxis guidelines on drug cost and frequency of major gastrointestinal bleeding.
Pharmacy study. Discontinue after pt. Gave cimetidine. A comparison of frequency of stress ulceration and secondary pneumonia in sucralfate-or ranitidine-treated intensive care unit patients. Single center RCT, 60 patients. Comparison: sucralfate versus ranitidine.
Outcome: stress ulceration, VAP, gastric pH. Prospective endoscopic study of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo. Effects of sucralfate versus antacids on gastric pathogens: results of a double-blind clinical trial.
Outcomes: gastric pH, pneumonia, GIB. No difference in pneumonia or GIB between the study groups. Increased gastric colonization in antacids vs sucralfate, unclear significance. Pneumonia and stress ulceration in severely injured patients. A prospective evaluation of the effects of stress ulcer prophylaxis. Single center RCT, trauma patients. Comparison: sucralfate, bolus cimetidine, infusion cimetidine. Outcome: Stress ulceration, pneumonia.
Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Retrospective study patients. Outcome: coffee-ground emesis or melena. A randomized, double-blind trial for stress ulcer prophylaxis shows no evidence of increased pneumonia. No difference between ranitidine and pirenzepine with regard to VAP. Placebo group had low incidence of GIB,? Randomized comparison of gastric pH control with intermittent and continuous intravenous infusion of famotidine in ICU patients.
No statistical difference in GI bleed, and hospital mortality. Single center RCT, patients. Comparison: omeprazole, famotidine, sucralfate, placebo. Outcome: GIB, pneumonia, gastric pH. No difference between any treatment arm and GIB, pneumonia. Increased gastric pH may increase pneumonia rate.
No difference in the bleeding based on the various treatments. Small study. A prospective study of omeprazole suspension to prevent clinically significant gastrointestinal bleeding from stress ulcers in mechanically ventilated trauma patients. Single center, retrospective study, 60 pts. Comparison: None. Outcome: GIB, gastric pH, pneumonia. Omeprazole suspension is safe and effective as prophylaxis.
Gastric pH is appropriately elevated. Omeprazole suspension is cost-effective. Single center prospective crossover trial, 10 pts. Outcome: gastric pH. Prospective RCT, single institution, 67 pts. Comparison: ranitidine, omeprazole. Outcome: pneumonia, GIB. Coagulopathy, burn, severe trauma, respiratory failure, coagulopathic, TBI, acute renal failure, sepsis. Higher number of GIB in the ranitidine group in comparison to omeprazole, 11 vs 2. Underpowered secondary to low incidence.
Unclear RE: risk factors. Duration not addressed. Single center RCT in 98 trauma patients. H2 blockers increase gastric pH more effectively, but no clinical difference in GIB episodes. Continuous intravenous cimetidine decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia.
Good multicenter, double-blinded, placebo controlled study to compare continuous IV cimetidine to nothing. Outcome: GIB,. Aggressive endoscopic surveillance in very ill SICU population. Prophylaxis may not eliminate mucosal lesions, but does decrease surgically significant bleeding. Impact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding: a prospective, multicenter, double-blind randomized trial.
Comparison: infusion ranitidine vs placebo. Outcome GIB. Good multicenter, double-blinded, placebo controlled study. Complications increased with 2 or more risk factors. Unclear definitions for UGIB. Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration: a randomized, controlled trial. Single center RCT, 20 patients. Comparison: sucralfate versus IV ranitidine.
Outcome: plasma aluminum samples. Acute stress bleeding prophylaxis with sucralfate versus ranitidine and incidence of secondary pneumonia in ICU patients. Single center RCT, 31 patients. Outcome: stress ulcer bleeding, pneumonia. Small study, sucralfate comparable to ranitidine.
Ranitidine increases gastric pH which may increase tracheobronchial colonization. Oral ranitidine as prophylaxis for gastric stress ulcers in intensive care unit patients: serum concentrations and cost comparisons. Single center prospective non-randomized trial, 18 patients. Comparison: ranitidine mg versus mg. Outcome: serum ranitidine concentrations. Only looked at ranitidine, oral administration ok and lower dose mg as effective as higher dose mg , given twice daily.
A prospective study of simplified omeprazole suspension for the prophylaxis of stress-related mucosal damage. Prospective, unrandomized, single center study, mixed SICU population outcome with omeprazole suspension.
A randomized, pharmacokinetic and pharmacodynamic, crossover study of duodenal or jejunal administration compared to nasogastric administration of omeprazole suspension in patients at risk for stress ulcers. Randomized crossover study, 9 surgical patients.
Comparison: gastric vs enteral route. Outcome: intragastric pH. Occurrence of nosocomial pneumonia in mechanically ventilated trauma patients: a comparison of sucralfate and ranitidine. Clinically significant gastrointestinal bleeding in critically ill patients in an era of prophylaxis. Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer.
A RCT. Comparison: antacids, ranitidine, sucralfate. SUP prophylaxis with sucralfate reduces the risk for late onset pneumonia in vented patients, with similar protection compared to antacids and ranitidine. Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications and value of prophylactic treatment. Single center, RCT, pts. Comparison: Cimetidine infusion versus sucralfate. Nice study with decent number of pts, 56 and 58 in each arm but focused on Nosocomial pneumonia and did not define UGI bleed.
Comparison: antacids vs cimetidine vs sucralfate. Outcome: Gastric pH, pneumonia. Overall rate of stress ulcer hemorrhage is low, with or without prophylaxis, the SCI population should continue for 3 wks. Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophylaxis with sucralfate, antacid and ranitidine. Comparison: Sucralfate, antacid, ranitidine. Outcome: Mortality, GIB, pneumonia.
Antacids associated with higher mortality compared to sucralfate and ranitidine which had equivalent GIB and pneumonia rates. The virtual absence of stress-ulcer related bleeding in ICU patients receiving prolonged mechanical ventilation. A prospective cohort study. Patients were considered high-risk with mean Tryba risk score of All patients received cefotaxime, steroids, and DVT prophylaxis.
Is the incidence of hemorrhagic stress ulceration in surgically critically ill patients affected by modern antacid prophylaxis? Single center retrospective study, pts. Outcome: Hemorrhagic stress ulceration. Multidisciplinary ICU with no difference in hemorrhage with or without H2 blockade, does not distinguish if trauma patients had differential stress ulcer hemorrhage.
Skip to main content Section Menu. Joseph Medical Center, Patterson, New Jersey Statement of the Problem Stress ulcer prophylaxis has historically been a disease process with a high degree of prevalence in the setting of burns and trauma.
Process A MEDLINE search was performed from the years to present with the following subject words: Gastrointestinal prophylaxis, gastrointestinal hemorrhage, intensive care unit, stress ulcer prophylaxis, trauma, and critical care. Quality of the references The initial literature review identified articles. Class III : A retrospective case series or database review. Recommendations What are the risk factors for stress ulcer development and which patients require prophylaxis?
Level 1 recommendations i. Prophylaxis is recommended for all patients with: Mechanical ventilation Coagulopathy Traumatic brain injury Major burn injury 2. Level 2 recommendations i. Level 3 recommendations i. In selected populations, no prophylaxis is necessary Is there a preferred agent for stress ulcer prophylaxis?
If so, which? There is no difference between H2 antagonists, cytoprotective agents, and some proton pump inhibitors ii. Antacids should not be used as stress ulcer prophylaxis. Aluminum containing compounds should not be used in patients on dialysis 3.
Enteral feeding alone may be insufficient stress ulcer prophylaxis What is the duration of prophylaxis? There were no level 1 recommendations 2. During mechanical ventilation or intensive care unit stay 3. Until able to tolerate enteral nutrition Scientific Foundation Historical Stress ulcer prophylaxis has been an important part of the care for critical illness for over 20 years.
Summary All critically ill patients with associated risk factors should receive chemical prophylaxis for stress ulceration. Comparison of the effect of intermittent administration and continuous infusion of famotidine on gastric pH in critically ill patients: results of a prospective, randomized, crossover study.
Crit Care Med ; Acid suppressive therapy use on an inpatient internal medicine service. Ann Pharmacother. Stress ulcer prophylaxis for non-critically ill patients on a teaching service. J Eval Clin Pract. Inappropriate continuation of stress ulcer prophylactic therapy after discharge. Ann Pharmachother. ASHP therapeutic guidelines on stress ulcer prophylaxis. Am J Health Syst Pharm. Janicki T, Stewart S. Stress-ulcer prophylaxis for general medical patients: a review of the evidence.
Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Intensive Care Med. Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial.
Coursol C, Sanzari S. Impact of stress ulcer prophylaxis algorithm study. Skip to main content. Medicolegal Issues. The Hospitalist. Background Stress-related mucosal disease SRMD refers to superficial erosions or focal ulceration of the proximal gastrointestinal mucosa resulting from physiologic demand in acute illness. South Med J. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med.
Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Health care costs and mortality associated with nosocomial diarrhea due to Clostridum difficile. Clin Infect Dis. Schroeder MS. Clostridium difficile —associated diarrhea. Am Fam Physician. Clostridium difficile : recent epidemiologic findings and advances in therapy.
Clostridium difficile colitis. Cunningham R, Dial S. Is over-use of proton pump inhibitors fuelling the current epidemic of Clostridium difficile -associated diarrhoea? J Hosp Infect. Vakil N. Acid inhibition and infections outside the gastrointestinal tract.
Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. Recurrent community-acquired pneumonia in patients starting acid-suppressing drugs. Sheen E, Triadafilopoulos G. Adverse effects on long-term proton pump inhibitor therapy. Dig Dis Sci. Dial MS. Proton pump inhibitor use and enteric infections. Systematic review: impaired drug absorption related to the co-administration of antisecretory therapy.
Aliment Pharmacol Ther. American Society of Health-System Pharmacists. Therapeutic guidelines. Accessed September 19,
0コメント