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ulcer prophylaxis in intensive care

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https://www.readbyqxmd.com/read/28646925/stress-ulcer-prophylaxis-versus-placebo-or-no-prophylaxis-in-adult-hospitalised-acutely-ill-patients-protocol-for-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis
#1
Søren Marker, Anders Perner, Jørn Wetterslev, Marija Barbateskovic, Janus Christian Jakobsen, Mette Krag, Anders Granholm, Carl Thomas Anthon, Morten Hylander Møller
BACKGROUND: Stress ulcer prophylaxis is considered standard of care in many critically ill patients in the intensive care unit (ICU). However, the quality of evidence supporting this has recently been questioned, and clinical equipoise exists. Whether there is overall benefit or harm of stress ulcer prophylaxis in adult hospitalised acutely ill patients is unknown. Accordingly, we aim to assess patient-important benefits and harms of stress ulcer prophylaxis versus placebo or no treatment in adult hospitalised acutely ill patients with high risk of gastrointestinal bleeding irrespective of hospital setting...
June 24, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28622739/impact-of-a-collaborative-strategy-to-reduce-the-inappropriate-use-of-acid-suppressive-therapy-in-non-intensive-care-unit-patients
#2
Kristen D Belfield, Arpi G Kuyumjian, Rafael Teran, Mariette Amadi, Melissa Blatt, Keri Bicking
BACKGROUND: Stress ulcer prophylaxis (SUP) is inappropriately prescribed in more than 30% of non-intensive care unit (ICU) patients, leading to unnecessary adverse events as well as increases in economic burden. OBJECTIVE: There was an increasing trend in the prophylactic use of acid suppressive therapy (AST) in non-critically ill patients at our institution, which prompted this initiative aimed at reducing the inappropriate use of AST in non-ICU patients. METHODS: This was a retrospective interventional study that consisted of formulation of a guideline, education to the hospitalist service, and intervention by clinical pharmacists...
July 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28608496/stress-ulcer-prophylaxis-in-the-intensive-care-unit-trial-detailed-statistical-analysis-plan
#3
M Krag, A Perner, J Wetterslev, T Lange, M P Wise, M Borthwick, S Bendel, P Pelosi, F Keus, A B Guttormsen, J C Schefold, T S Meyhoff, S Marker, M H Møller
BACKGROUND: In this statistical analysis plan, we aim to provide details of the pre-defined statistical analyses of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial. The aim of the SUP-ICU trial is to assess benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in adult patients in the intensive care unit (ICU). METHODS: The SUP-ICU trial is an investigator-initiated, international, multicentre, randomised, blinded, parallel-group trial of intravenously pantoprazole 40 mg once daily vs...
June 12, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28572098/prophylactic-acid-suppressive-therapy-in-hospitalized-adults-indications-benefits-and-infectious-complications
#4
Andrew C Faust, Kelly L Echevarria, Rebecca L Attridge, Lyndsay Sheperd, Marcos I Restrepo
Acid-suppressive therapy for prophylaxis of stress ulcer bleeding is commonly prescribed for hospitalized patients. Although its use in select, at-risk patients may reduce clinically significant gastrointestinal bleeding, the alteration in gastric pH and composition may place these patients at a higher risk of infection. Although any pharmacologic alteration of the gastric pH and composition is associated with an increased risk of infection, the risk appears to be highest with proton pump inhibitors, perhaps owing to the potency of this class of drugs in increasing the gastric pH...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28533916/pediatric-intensive-care-stress-ulcer-prevention-pic-up-a-protocol-for-a-pilot-randomized-trial
#5
Mark Duffett, Karen Choong, Jennifer Foster, Elaine Gilfoyle, Jacques Lacroix, Nikhil Pai, Lehana Thabane, Deborah J Cook
BACKGROUND: Despite sparse pediatric data on effectiveness, the majority of critically ill children receive medications to prevent gastrointestinal (GI) bleeding. Stress ulcer prophylaxis may have unintended consequences-increasing the risk of nosocomial infections-which may be more serious and common than the bleeding which these drugs are prescribed to prevent. Randomized controlled trials (RCTs) in pediatric critical care are exceptionally challenging to complete, thus a rigorous pilot RCT is crucial...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/28507939/variables-associated-with-adherence-to-stress-ulcer-prophylaxis-in-patients-admitted-to-the-general-hospital-wards-a-prospective-study
#6
Shadi Farsaei, Sajad Ghorbani, Payman Adibi
Purpose: The dramatic increase in stress ulcer prophylaxis (SUP) prescribing patterns over the past several years has raised concerns regarding to their appropriate utilization. This prospective study attempted to evaluate the trend of adherence to stress ulcer prophylaxis from admission until discharge in non- Intensive care unit (ICU) setting. Additionally, we attempted to find those variables associated with appropriate SUP administration. Methods: Data collection was performed prospectively to evaluate 195 randomly selected adult patients who received SUP or had indication for that in non-ICU wards of one of the largest referral center in Iran, during 6 months...
April 2017: Advanced Pharmaceutical Bulletin
https://www.readbyqxmd.com/read/28461706/possibilities-for-modifying-risk-factors-for-the-development-of-hospital-acquired-pneumonia-in-intensive-care-patients-results-of-a-retrospective-observational-study
#7
Radovan Uvizl, Milan Kolar, Tomas Herkel, Michaela Vobrova, Katerina Langova
BACKGROUND: Hospital-acquired pneumonia (HAP) development is affected by a range of risk factors. METHODS: A retrospective, observational study processing data on all consecutive intensive care patients older than 18 years of age between 1 January 2011 and 31 December 2015. The aim was to determine the incidence of potential risk factors and their impact on the development of HAP. RESULTS: A total of 2229 patients. The overall mortality was 24...
April 26, 2017: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
https://www.readbyqxmd.com/read/28279999/simplified-mortality-score-for-the-intensive-care-unit-sms-icu-protocol-for-the-development-and-validation-of-a-bedside-clinical-prediction-rule
#8
Anders Granholm, Anders Perner, Mette Krag, Peter Buhl Hjortrup, Nicolai Haase, Lars Broksø Holst, Søren Marker, Marie Oxenbøll Collet, Aksel Karl Georg Jensen, Morten Hylander Møller
INTRODUCTION: Mortality prediction scores are widely used in intensive care units (ICUs) and in research, but their predictive value deteriorates as scores age. Existing mortality prediction scores are imprecise and complex, which increases the risk of missing data and decreases the applicability bedside in daily clinical practice. We propose the development and validation of a new, simple and updated clinical prediction rule: the Simplified Mortality Score for use in the Intensive Care Unit (SMS-ICU)...
March 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28185627/epidemiology-of-bleeding-in-critically-ill-children
#9
Lauren J White, Ryan Fredericks, Candace N Mannarino, Stephen Janofsky, Edward Vincent S Faustino
OBJECTIVE: To determine the epidemiology of bleeding in critically ill children. STUDY DESIGN: We conducted a cohort study of children <18 years old admitted to the pediatric intensive care unit for >24 hours and without clinically relevant bleed (CRB) on admission. CRB was defined as resulting in severe physiologic derangements, occurring at a critical site or requiring major therapeutic interventions. Using a novel bleeding assessment tool that we developed, characteristics of the CRB were abstracted from the medical records independently and in duplicate...
May 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28156498/prevention-of-everolimus-exemestane-eve-exe-stomatitis-in-postmenopausal-pm-women-with-hormone-receptor-positive-hr-metastatic-breast-cancer-mbc-using-a-dexamethasone-based-mouthwash-mw-results-of-the-swish-trial
#10
J Thaddeus Beck, John A Glaspy, Julio Antonio Peguero, Timothy J Pluard, Navneet Dhillon, Leon C Hwang, Chaitali Singh Nangia, Ingrid A Mayer, Timothy F Meiller, Mark Steven Chambers, Ghulam Warsi, Robert William Sweetman, J Randy Sabo, Lasikas Seneviratne
189 Background: Stomatitis is a frequent adverse event (AE) associated with mTOR inhibition. In BOLERO-2 patients (pts) receiving EVE/EXE, all grade (Gr) stomatitis was 67%; 33% had Gr ≥ 2 and 8% Gr 3. Median time to ≥ Gr 2 onset was 15.5 days; incidence of new stomatitis (Gr ≥ 2) plateaued at 6 wks. In a meta-analysis, 89% of first stomatitis events occurred within 8 wks. Topical steroids are used to treat aphthous ulcers; anecdotal use as prophylaxis has been reported. METHODS: Eligibility included PM women with HR+ MBC prescribed EVE/EXE...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152722/integrating-lean-six-sigma-in-the-daily-operations-of-an-icu-to-achieve-safe-quality-patient-care
#11
Jacqueline Magurn, Joanne McGovern, Michelle Jetter, Sarah Beadling, Dorothy Gregoire
230 Background: Developing and maintaining a culture of safety and quality in delivering patient care is critical in the intensive care unit (ICU) especially an oncology ICU. Incorporating the Lean Six Sigma program into daily operations of the ICU achieves, simplifies, and sustains continuous improvement in the delivery of safe quality patient care. This program engages the ICU team through visual management of quality, safety, and budget indicators including medication scanning, falls, sharps exposure, infection prevention including blood stream, catheter, hospital and ventilator acquired pneumonias, venous embolism prevention, and staffing compliance...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28110095/prophylaxis-for-stress-ulcers-with-proton-pump-inhibitors-is-not-associated-with-increased-risk-of-bloodstream-infections-in-the-intensive-care-unit
#12
Margot E Cohen, Joanne M Hathway, Hojjat Salmasian, Jianfang Liu, Melissa Terry, Julian A Abrams, Daniel E Freedberg
BACKGROUND & AIMS: Proton pump inhibitors (PPIs) have been associated with increased risk of infection, likely because of changes in intestinal epithelial permeability and the gastrointestinal microbiome. PPIs are frequently given to patients in the intensive care unit (ICU) to prevent stress ulcers. These patients are at risk for bloodstream infections (BSIs), so we investigated the relationship between PPI use and BSIs among patients in the ICU. METHODS: We performed a retrospective cohort study of adults (≥18 years) admitted to 1 of 14 ICUs within a hospital network of 3 large hospitals from 2008 through 2014...
July 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28093644/guidelines-for-proton-pump-inhibitor-prescriptions-in-paediatric-intensive-care-unit
#13
P Joret-Descout, S Dauger, M Bellaiche, O Bourdon, S Prot-Labarthe
Background Stress ulcer prophylaxis (SUP) is recommended in some situations to prevent upper gastrointestinal bleeding and is a component of standard care for patients admitted to the intensive care unit (ICU). Proton pump inhibitors (PPIs), already among the most widely prescribed drug classes, are being increasingly used. Objective To describe PPI prescribing patterns and their changes after the dissemination of guidelines. Setting Paediatric ICU (PICU), Robert-Debré Teaching Hospital, Paris, France, which admits about 800 patients annually, from full-term neonates to 18-year-olds...
February 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28006826/predictive-performance-of-the-simplified-acute-physiology-score-saps-ii-and-the-initial-sequential-organ-failure-assessment-sofa-score-in-acutely-ill-intensive-care-patients-post-hoc-analyses-of-the-sup-icu-inception-cohort-study
#14
Anders Granholm, Morten Hylander Møller, Mette Krag, Anders Perner, Peter Buhl Hjortrup
PURPOSE: Severity scores including the Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score are used in intensive care units (ICUs) to assess disease severity, predict mortality and in research. We aimed to assess the predictive performance of SAPS II and the initial SOFA score for in-hospital and 90-day mortality in a contemporary international cohort. METHODS: This was a post-hoc study of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) inception cohort study, which included acutely ill adults from ICUs across 11 countries (n = 1034)...
2016: PloS One
https://www.readbyqxmd.com/read/27920416/re-evaluating-the-inhibition-of-stress-erosions-revise-a-protocol-for-pilot-randomized-controlled-trial
#15
RANDOMIZED CONTROLLED TRIAL
Waleed Alhazzani, Gordon Guyatt, John C Marshall, Richard Hall, John Muscedere, Francois Lauzier, Lehana Thabane, Mohammed Alshahrani, Shane W English, Yaseen M Arabi, Adam M Deane, Tim Karachi, Bram Rochwerg, Simon Finfer, Nick Daneman, Nicole Zytaruk, Diane Heel-Ansdell, Deborah Cook, On Behalf Of
INTRODUCTION: Clinicians routinely administer stress ulcer prophylaxis to mechanically ventilated patients in the intensive care unit (ICU), most commonly prescribing proton pump inhibitors (PPIs). However, the incidence of gastrointestinal (GI) bleeding from stress ulceration is low and recent observational studies suggest these agents may increase infections. Therefore, a large randomized clinical trial (RCT) is needed to inform modern practice. The aim of this multicenter pilot trial is to determine the feasibility of performing a large RCT to investigate the efficacy and safety of withholding intravenous pantoprazole...
November 2016: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/27903209/incidence-and-cost-of-stress-ulcer-prophylaxis-after-discharge-from-the-intensive-care-unit-a-retrospective-study
#16
MULTICENTER STUDY
Benedict Tan, Richard Norman, Ed Litton, Chloe Heath, David J Hawkins, Ravi Krishnamurthy, Ravikiran Sonawane, Matthew H Anstey
OBJECTIVE: To describe current patterns in initiation and cessation of proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) in intensive care units, and to assess the costs associated with inappropriate (non-evidence-based) SUP. DESIGN, SETTING AND PARTICIPANTS: Retrospective observational study in five ICUs in Western Australia. We assessed the medical records of consecutive patients admitted to the ICUs between September 2013 and January 2015. Patients aged < 18 years were excluded...
December 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27884335/pneumonia-prevention-in-intubated-patients-given-sucralfate-versus-proton-pump-inhibitors-and-or-histamine-ii-receptor-blockers
#17
COMPARATIVE STUDY
Gene A Grindlinger, Sarah B Cairo, Carole B Duperre
BACKGROUND: Ventilator-associated pneumonia (VAP) is a common cause of infectious morbidity and mortality in the intensive care unit (ICU). The type of stress-ulcer prophylaxis (SUP) given to ventilated patients may, in part, be responsible. We observed an increase in VAP as ventilator bundle compliance increased and a decrease in VAP when bundle compliance decreased. We reasoned that SUP which raises gastric pH such as proton-pump inhibitors (PPIs) and histamine II (H2) receptor antagonists as opposed to SUP which does not raise pH such as sucralfate (S) may be responsible and also may alter the causative bacteria...
December 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27837045/pharmacologic-stress-gastropathy-prophylaxis-may-not-be-necessary-in-at-risk-surgical-trauma-icu-patients-tolerating-enteral-nutrition
#18
Nicole M Palm, Brian McKinzie, Pamela L Ferguson, Emily Chapman, Margaret Dorlon, Evert A Eriksson, Brent Jewett, Stuart M Leon, Alicia R Privette, Samir M Fakhry
OBJECTIVE: Stress gastropathy is a rare complication of the intensive care unit stay with high morbidity and mortality. There are data that support the concept that patients tolerating enteral nutrition have sufficient gut blood flow to obviate the need for prophylaxis; however, no robust studies exist. This study assesses the incidence of clinically significant gastrointestinal bleeding in surgical trauma intensive care unit (STICU) patients at risk of stress gastropathy secondary to mechanical ventilation receiving enteral nutrition without pharmacologic prophylaxis...
November 10, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27809338/cost-effectiveness-of-histamine2-receptor-antagonists-versus-proton-pump-inhibitors-for-stress-ulcer-prophylaxis-in-critically-ill-patients
#19
COMPARATIVE STUDY
Drayton A Hammond, Niranjan Kathe, Anuj Shah, Bradley C Martin
STUDY OBJECTIVE: To determine the cost-effectiveness of stress ulcer prophylaxis with histamine2 receptor antagonists (H2RAs) versus proton pump inhibitors (PPIs) in critically ill and mechanically ventilated adults. DESIGN: A decision analytic model estimating the costs and effectiveness of stress ulcer prophylaxis (with H2RAs and PPIs) from a health care institutional perspective. PATIENTS: Adult mixed intensive care unit (ICU) population who received an H2RA or PPI for up to 9 days...
January 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/27784575/the-appropriate-use-of-proton-pump-inhibitors-ppis-need-for-a-reappraisal
#20
REVIEW
Vincenzo Savarino, Pietro Dulbecco, Nicola de Bortoli, Andrea Ottonello, Edoardo Savarino
The advent of powerful acid-suppressive drugs, such as proton pump inhibitors (PPIs), has revolutionized the management of acid-related diseases and has minimized the role of surgery. The major and universally recognized indications for their use are represented by treatment of gastro-esophageal reflux disease, eradication of Helicobacter pylori infection in combination with antibiotics, therapy of H. pylori-negative peptic ulcers, healing and prophylaxis of non-steroidal anti-inflammatory drug-associated gastric ulcers and control of several acid hypersecretory conditions...
January 2017: European Journal of Internal Medicine
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