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Published on: January 16, 2019
Acute stress ulceration prophylaxis: point prevalence surveys in intensive care units in Victoria, 1997 and 2005
Megan S Robertson1, Stuart J Wilson, John F Cade
1Royal Melbourne Hospital, Melbourne, VIC, Australia. m.robertson@alfred.org.au.
Objective:
To assess current practice in acute stress ulceration (ASU) prophylaxis in adult intensive care units in Victoria, Australia, in 1997 and 2005.
Methods:
Point prevalence surveys using a structured telephone questionnaire of ASU prophylaxis practices were performed in adult ICUs in Victoria on 11 November 1997 and 13 April 2005.
Results:
All Victorian ICUs identified on each study day participated, comprising 30 ICUs in 1997 and 35 ICUs in 2005. Presence of a clinical protocol or guideline for ASU prophylaxis increased significantly from 23% in 1997 to 54% in 2005 (P = 0.01). Overall provision of ASU prophylaxis to ICU patients also increased significantly from 67% in 1997 to 86% in 2005 (P < 0.001). H2-receptor antagonists were the preferred first-line agent in at least 50% of ICUs, and were also the most commonly used agents in both point prevalence surveys, with no change over 8 years. Use of proton-pump inhibitors increased significantly, both as first-line ASU prophylaxis agents and in clinical use, from 13% in 1997 to 45% in 2005 (P < 0.001). Use of sucralfate and antacids for ASU prophylaxis ceased between 1997 and 2005.
Conclusions:
Use of ASU prophylaxis for patients admitted to Victorian ICUs increased significantly from 1997 to 2005, with an associated increase in the presence of protocols or guidelines for ASU prophylaxis. Although agents currently used for ASU prophylaxis in Victorian ICUs are consistent with available evidence, we are concerned that ASU prophylaxis is given to all patients admitted to the ICU rather than targeted to patients in high-risk categories.
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