Opinions and practice of stress ulcer prophylaxis in australian and new zealand intensive care units. Eastwood, G., M., Litton, E., Bellomo, R., Bailey, M., J., Festa, M., Beasley, R., W., & Young, P., J. Critical Care and Resuscitation, 16(3):170-174, 2014.
Opinions and practice of stress ulcer prophylaxis in australian and new zealand intensive care units [pdf]Paper  abstract   bibtex   
BACKGROUND: Intensivists frequently prescribe proton pump inhibitors (PPIs) or histamine-2 receptor blockers (H2RBs) to intensive care unit patients for stress ulcer prophylaxis (SUP). Despite the common use of SUP medicines, there is limited high-level evidence to support the choice between them. AIM: To describe self-reported practice of SUP by Australian and New Zealand intensivists. METHOD: An online questionnaire of intensivists between 13 January and 3 February 2014. RESULTS: Seventy-two intensivists responded to the survey: 61 (85%) practised in public metropolitan ICUs and 13/48 (27%) practised in paediatric ICUs. Fifty-two (72%) respondents indicated that PPIs were their preferred SUP medicine. Respondents estimated that an average of 84% of ventilated and 53% of non-ventilated patients received SUP medicines during their ICU admission. Seven respondents (9%) were concerned or very concerned about the possible increased risk of upper gastrointestinal bleeding associated with H2RBs versus PPIs. Ten respondents (14%) were concerned or very concerned about the possible greater risk of Clostridium difficile infection, and 15 respondents (21%) were concerned or very concerned about the possible greater risk or ventilator-associated pneumonia with PPIs versus H2RBs. Most respondents (64 [89%]) agreed or strongly agreed that there was insufficient evidence to support the choice of an optimal SUP medicine, and 58 respondents (81%) agreed or strongly agreed to patient enrollment in an RCT comparing PPIs with H2RBs. CONCLUSION: Most survey respondents felt that current evidence is insufficient to justify the preferential use of PPIs or H2RBs for SUP and would enroll patients in a comparative SUP RCT.

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