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A survey of stress ulcer prophylaxis practice patterns for critically ill patients before and after participating in
Akira Kuriyama1, Nicole Zytaruk2, Jeffrey F Barletta3
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Background:
Prescribing patterns for stress ulcer prophylaxis (SUP) may change over time as randomised controlled trials evaluate proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) for critically ill patients in the intensive care unit (ICU).
Objectives:
The objective of this study was to compare site-specific, self-reported SUP prescribing and management practices before and after publication of the Re-Evaluating the Inhibition of Stress Erosions (REVISE) trial in participating ICUs.
Methods:
This was a preplanned study as part of the REVISE trial (NCT03374800), which compared intravenous pantoprazole with placebo in mechanically ventilated patients. The REVISE trial showed that intravenous pantoprazole reduced the risk of clinically important upper gastrointestinal bleeding and patient-important upper gastrointestinal bleeding, without a significant effect on mortality or other clinical outcomes. We conducted a survey of REVISE teams (one response from each pair of research coordinators and site physicians) in 68 participating sites to record their unit-based SUP practice patterns. Surveys were completed both before the site started enrolling patients and 10 months after the REVISE trial publication (response rate: 100%).
Results:
A total of 58 sites (85.3%) and 65 sites (95.6%) included PPIs for SUP before and after the REVISE trial (P = 0.039). The most common indication for SUP discontinuation was extubation, followed by feed-related indications and ICU discharge during the pre-trial phase, which was similar after the trial. Order sets were used in 44 (64.7%) and 52 (76.5%) of sites in the pre-trial and post-trial phases, respectively (P = 0.022).
Conclusions:
In this survey of unit-based self-reported SUP practices before and after participation in a randomised trial, we found an increase in the use of PPIs and order sets, but strategies for discontinuation were unchanged.
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