Stress Ulcer Prophylaxis in Critically Ill Children: A Multicenter Observational Study

Area of Science:

• Pediatric Critical Care Medicine
• Pharmacology
• Gastroenterology

Background:

• Stress ulcer prophylaxis (SUP) is frequently administered to critically ill children.
• Current practices in Canadian pediatric intensive care units (PICUs) for SUP are not well-described.

Purpose of the Study:

• To describe the current practices of stress ulcer prophylaxis in Canadian PICUs.
• To identify factors associated with the use of SUP in mechanically ventilated children.

Main Methods:

• A multicenter cohort study was conducted across seven Canadian PICUs.
• Defined SUP as the use of proton-pump inhibitors, histamine-2 receptor antagonists, or sucralfate within the first two PICU days.
• Included 378 children requiring mechanical ventilation; analyzed data on medication use, patient characteristics, and outcomes.

Main Results:

• Seventy percent of all children received acid suppression during their PICU stay.
• 54% of eligible children received SUP, with histamine-2 receptor antagonists being the most common class.
• Older age, higher Pediatric Risk of Mortality III score, use of NSAIDs/corticosteroids, and invasive mechanical ventilation were associated with increased SUP use; enteral nutrition was associated with decreased use.
• Clinically important gastrointestinal bleeding occurred in 0.8% of children; C. difficile-associated diarrhea in 1%.

Conclusions:

• Stress ulcer prophylaxis is widely used in Canadian PICUs.
• The low incidence of clinically important gastrointestinal bleeding suggests that the utility of routine SUP should be critically evaluated.
• Further research is needed to optimize SUP strategies in pediatric critical care.