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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 6/2016

01-06-2016 | Reports of Original Investigations

Stress ulcer prophylaxis in critical illness: a Canadian survey

Authors: Melissa Shears, BSc, Waleed Alhazzani, MBBS, John C. Marshall, MD, John Muscedere, MD, Richard Hall, MD, Shane W. English, MD, Peter M. Dodek, MD, François Lauzier, MD, Salmaan Kanji, BSc, PharmD, Mark Duffett, MSc, RPh, Jeffrey Barletta, PharmD, Mohammed Alshahrani, MD, Yaseen Arabi, MD, Adam Deane, MBBS, PhD, Deborah J. Cook, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 6/2016

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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.
Appendix
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Metadata
Title
Stress ulcer prophylaxis in critical illness: a Canadian survey
Authors
Melissa Shears, BSc
Waleed Alhazzani, MBBS
John C. Marshall, MD
John Muscedere, MD
Richard Hall, MD
Shane W. English, MD
Peter M. Dodek, MD
François Lauzier, MD
Salmaan Kanji, BSc, PharmD
Mark Duffett, MSc, RPh
Jeffrey Barletta, PharmD
Mohammed Alshahrani, MD
Yaseen Arabi, MD
Adam Deane, MBBS, PhD
Deborah J. Cook, MD
Publication date
01-06-2016
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 6/2016
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-016-0612-3

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