Stress Ulcer Prophylaxis for Critical Asthma

Area of Science:

• Pediatric Critical Care Medicine
• Pharmacology
• Gastroenterology

Background:

• Children hospitalized for critical asthma (CA) in the pediatric intensive care unit (PICU) are frequently prescribed stress ulcer prophylaxis (SUP).
• This practice aims to prevent gastrointestinal (GI) bleeding, a potential complication in critically ill children.
• However, the actual benefit and necessity of routine SUP in this population warrant investigation.

Purpose of the Study:

• To analyze trends in stress ulcer prophylaxis (SUP) prescribing for children with critical asthma (CA) admitted to the pediatric intensive care unit (PICU).
• To compare the incidence of GI bleeding, gastritis, and SUP-related complications between children who received SUP and those who did not.
• To evaluate the appropriateness of SUP use in this specific pediatric patient group.

Main Methods:

• A retrospective, multicenter cohort study was conducted using data from the Pediatric Hospital Information System registry (2010-2019).
• The study included children aged 3-17 years admitted to the PICU for CA across 42 children's hospitals.
• Joinpoint regression and Pearson's correlation were used to assess temporal and regional prescribing variations, alongside comparisons of clinical outcomes between SUP-exposed and non-exposed groups.

Main Results:

• Out of 30,177 children studied, 34.4% received stress ulcer prophylaxis (SUP).
• No gastrointestinal bleeding episodes were recorded; one case of gastric ulceration and 32 cases of gastritis (0.1%) were observed.
• SUP prescribing rates increased linearly from 25.5% in 2010 to 42.1% in 2019, with significant institutional variation and rare SUP-related complications.

Conclusions:

• Despite routine stress ulcer prophylaxis (SUP) use in critically ill asthmatic children, gastrointestinal bleeding was not observed over a decade.
• SUP solely for corticosteroid exposure may be unnecessary in this patient cohort.
• A more targeted approach to SUP, considering specific risk factors for GI bleeding, is recommended.