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ulcer prophylaxis in intensive care

Manasi Hulyalkar, Stephen J Gleich, Rahul Kashyap, Amelia Barwise, Harsheen Kaur, Yue Dong, Lei Fan, Srinivas Murthy, Grace M Arteaga, Sandeep Tripathi
Increasing process complexity in the pediatric intensive care unit (PICU) can lead to information overload resulting in missing pertinent information and potential errors during morning rounds. An efficient model using a novel electronic rounding tool was designed as part of a broader critical care decision support system-checklist for early recognition and treatment of acute illness and injury in pediatrics (CERTAINp). We aimed to evaluate its impact on improving the process of care during rounding. Prospective pre- and post-interventional data included: team performance baseline assessment, patient safety discussion, guideline adherence, rounding time, and a survey of Residents' and Nurses' perception using a Likert scale...
October 18, 2016: Journal of Clinical Monitoring and Computing
Young Hwan Choi, Jong Ho Lee, Jae Jun Shin, Young Soon Cho
OBJECTIVE: Most of the literature about Curling's ulcer was published from 1960 through 1980. Therefore, an updated study of Curling's ulcer is needed. We analyzed the risk factors affecting ulcer incidence in burn patients. METHODS: We retrospectively analyzed the medical records of burn patients who were admitted to two burn centers. We collected information about the general characteristics of patients, burn area size, abbreviated burn severity index, whether surgery was performed, endoscopy results, and the total body surface area (TBSA)...
December 2015: Clin Exp Emerg Med
Niloofar Rafinazari, Saeed Abbasi, Shadi Farsaei, Marjan Mansourian, Peyman Adibi
OBJECTIVE: Concern about adverse effects of the inconsistent use of stress-related mucosal damage prophylaxis in intensive care unit (ICU) is increasing. Hence, this study was designed to prospectively evaluate the rate of inappropriate stress ulcer prophylaxis (SUP) administration upon ICU admission, at ICU discharge and determine the adherence to American Society of Health-System Pharmacists (ASHP) guideline during ICU stay. METHODS: In this study, 200 patients were randomly selected from all ICU admissions during 9 months...
July 2016: Journal of Research in Pharmacy Practice
Mette Krag, Anders Perner, Jørn Wetterslev, Matt P Wise, Mark Borthwick, Stepani Bendel, Paolo Pelosi, Frederik Keus, Anne Berit Guttormsen, Joerg C Schefold, Morten Hylander Møller
BACKGROUND: Critically ill patients in the intensive care unit (ICU) are at risk of clinically important gastrointestinal bleeding, and acid suppressants are frequently used prophylactically. However, stress ulcer prophylaxis may increase the risk of serious adverse events and, additionally, the quantity and quality of evidence supporting the use of stress ulcer prophylaxis is low. The aim of the SUP-ICU trial is to assess the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in adult patients in the ICU...
2016: Trials
Vickie Larrow, Eira I Klich-Heartt
Ventilated-associated pneumonia (VAP) is a major concern for hospitals and a major problem for ventilated patients in the intensive care unit. Included in the basics are hand hygiene, wearing gloves, endotracheal tube suctioning, head of bed at 30°, stress ulcer prophylaxis, turning patient side to side at least every two hours, and giving the patient a sedation vacation each morning. Beyond the basics included here are oral hygiene, oral suctioning, endotracheal tube cuff pressure, artificial humidification, the difference in practice between registered nurses and respiratory therapists, using the beach chair position and early mobilization, and the VAP bundle...
June 2016: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Youngouk Ro, Chang Soo Eun, Hyun Soo Kim, Ji Yeoun Kim, Young Jae Byun, Kyo-Sang Yoo, Dong Soo Han
BACKGROUND/AIMS: Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly prescribed for stress ulcer prophylaxis (SUP) in critically ill patients. Several studies have suggested that the use of PPIs is a potential risk factor for Clostridium difficile infection (CDI). We compared the incidences of CDI in the PPI group and H2RA group for SUP in critically ill patients. METHODS: From August 2005 to July 2012, the incidences of CDI were retrospectively analyzed in patients who were admitted directly to intensive care units and stayed for more than 3 days...
July 15, 2016: Gut and Liver
Raymond Khan, Hasan M Al-Dorzi, Khalid Al-Attas, Faisal Wali Ahmed, Abdellatif M Marini, Shihab Mundekkadan, Hanan H Balkhy, Joseph Tannous, Adel Almesnad, Dianne Mannion, Hani M Tamim, Yaseen M Arabi
BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates. METHODS: All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria...
March 1, 2016: American Journal of Infection Control
Melissa Shears, Waleed Alhazzani, John C Marshall, John Muscedere, Richard Hall, Shane W English, Peter M Dodek, François Lauzier, Salmaan Kanji, Mark Duffett, Jeffrey Barletta, Mohammed Alshahrani, Yaseen Arabi, Adam Deane, Deborah J Cook
PURPOSE: Stress ulcer prophylaxis (SUP) using histamine-2-receptor antagonists has been a standard of care in intensive care units (ICUs) for four decades. Proton pump inhibitors (PPIs) are increasingly used despite apparently lower background rates of gastrointestinal bleeding and growing concerns about PPI-associated complications. Our objective was to understand the views and prescribing habits amongst Canadian physicians regarding SUP in the ICU and to gauge interest in a future randomized-controlled trial (RCT)...
June 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Lukas Buendgens, Alexander Koch, Frank Tacke
Stress-related mucosal disease is a typical complication of critically ill patients in the intensive care unit (ICU). It poses a risk of clinically relevant upper gastrointestinal (GI) bleeding. Therefore, stress ulcer prophylaxis (SUP) is recommended in high-risk patients, especially those mechanically ventilated > 48 h and those with a manifest coagulopathy. Proton pump inhibitors (PPI) and, less effectively, histamine 2 receptor antagonists (H2RA) prevent GI bleeding in critically ill patients in the ICU...
February 4, 2016: World Journal of Critical Care Medicine
Mette Krag, Anders Perner, Morten H Møller
PURPOSE OF REVIEW: Stress ulcer prophylaxis (SUP) is considered standard of care in the majority of critically ill patients in the ICU. In this review, we will present the current evidence for the use of SUP in ICU patients, including data on the prevalence of gastrointestinal bleeding and the balance between benefits and harms of SUP. RECENT FINDINGS: The prevalence of overt gastrointestinal bleeding in critically ill patients is in the area of 5%. Consistent risk factors for gastrointestinal bleeding have been identified, but indications for SUP vary considerably...
April 2016: Current Opinion in Critical Care
Roberta E Redfern, Megan Brown, Kathryn L Karhoff, Jennifer L Middleton
OBJECTIVES: Acid-suppressive therapy (AST) is widely used for gastrointestinal prophylaxis in hospitalized patients, particularly to prevent stress-related mucosal bleeding in critically ill individuals. Previous reports suggest gross overutilization and continuation of unnecessary therapy, which have been linked to several adverse effects. METHODS: Retrospective chart review at a large tertiary care hospital, evaluating the use of AST for ulcer prophylaxis in accordance with American Society of Health-System Pharmacists' guidelines and the less commonly studied nonsteroidal anti-inflammatory drug-related ulcer prophylaxis guidelines...
December 2015: Southern Medical Journal
Jérôme Ouellet, Dennis Bailey, Marie-Ève Samson
OBJECTIVE: To describe current opinions about stress-related mucosal disease (SRMD) prevention in Canadian pediatric intensive care units (PICUs). METHODS: A 22-question survey covering several aspects of SRMD was sent to all identified PICU attendings in Canada. RESULTS: Sixty-eight percent of identified attendings completed the questionnaire. Thirty-eight percent were based in Quebec, 31% in Alberta, and 31% from other provinces. Most attendings (78%) had worked in a PICU for 6 years or more...
July 2015: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Nikhil Meena, Marcus Costner, Manish Joshi
PURPOSE: We hypothesize that stress ulcer prophylaxis with acid suppressant medications (ASM) is overused and educating house-staff will decrease this. METHODS: Retrospective chart review in two six-month phases. House staff was educated prior to phase II. Rates of SUP were calculated for ICU stay, medicine floor, and at discharge. RESULTS: There were 625 ICU admissions. Analysis was done on 106 and 118 patients in each phase. SUP use decreased from 62% to 37% in patients with no indications (p value < 0...
August 2015: Journal of the Arkansas Medical Society
Gary E Weissman, Nicole B Gabler, Sydney E S Brown, Scott D Halpern
PURPOSE: The purpose of the study is to examine the relationship between different measures of capacity strain and adherence to prophylaxis guidelines in the intensive care unit (ICU). MATERIALS AND METHODS: We conducted a retrospective cohort study within the Project IMPACT database. We used multivariable logistic regression to examine relationships between ICU capacity strain and appropriate usage of venous thromboembolism prophylaxis (VTEP) and stress ulcer prophylaxis (SUP)...
December 2015: Journal of Critical Care
Mauricio Tejeda-Miranda, Francisco Javier Anthon-Mendez, Juan Gerardo Esponda-Prado, Mario Enrique Rendón-Macías
BACKGROUND: The aim of this article is to evaluate the quality of care in intensive care, with international quality indices. METHODS: It was a descriptive study in an intensive care private care in Mexico. 2012 indicators are analyzed in a total of 446 hospital patients. The quality indicators were in line with international recommendations. The severity was determined by the scale SAPS III. RESULTS: Indicator of ventilation associated pneumonia was below the recommended standard (11...
July 2015: Revista Médica del Instituto Mexicano del Seguro Social
Haitao Lan, Charat Thongprayoon, Adil Ahmed, Vitaly Herasevich, Priya Sampathkumar, Ognjen Gajic, John C O'Horo
Ventilator-associated events (VAEs) are associated with increased risk of poor outcomes, including death. Bundle practices including thromboembolism prophylaxis, stress ulcer prophylaxis, oral care, and daily sedation breaks and spontaneous breathing trials aim to reduce rates of VAEs and are endorsed as quality metrics in the intensive care units. We sought to create electronic search algorithms (digital signatures) to evaluate compliance with ventilator bundle components as the first step in a larger project evaluating the ventilator bundle effect on VAE...
2015: BioMed Research International
Minh T Hong, Leslie C Monye, Charles F Seifert
BACKGROUND: The current literature discourages the use of acid suppressive therapy (AST) for stress ulcer prophylaxis (SUP) in noncritically ill patients. However, several sources indicate that the majority of noncritically ill patients are given AST for SUP while there may only be a small proportion of high-risk patients who need SUP therapy. There is a new scoring system to aid practitioners in stratifying the risk of stress ulcer-related gastrointestinal bleeding in noncritically ill patients developed by Herzig et al and appropriately prescribe AST for SUP in this population...
September 2015: Annals of Pharmacotherapy
Sooyoung Shin
BACKGROUND: Stress ulcers and related upper gastrointestinal bleeding are well-known complications in intensive care unit (ICU) patients. Proton pump inhibitor (PPI)-based stress ulcer prophylaxis (SUP) has been widely prescribed in noncritically ill patients who are at low risk for clinically significant bleeding, which is then injudiciously continued after hospital discharge. This study aimed to evaluate the incidence of inappropriate prescribing of PPI-based preventative therapy in ICU versus non-ICU patients that subsequently continued postdischarge, and to estimate the costs incurred by the unwarranted outpatient continuation of PPI therapy...
2015: Therapeutics and Clinical Risk Management
Christina Agee, Lois Coulter, Jonell Hudson
OBJECTIVE: Overutilization of stress ulcer prophylaxis in both critically and noncritically ill patients poses significant health risks and increases healthcare costs. The purpose of this study was to assess the impact of education for appropriate stress ulcer prophylaxis prescribing by Family Medicine Resident Physicians. METHODS: The study evaluated the SUP prescribing and continuation or discontinuation of acid suppressive therapy upon discharge. Patients admitted to the Family Medicine Residency team at Washington Regional Medical Center were retrospectively assessed from September through November 2011...
June 1, 2015: American Journal of Health-system Pharmacy: AJHP
M Krag, A Perner, J Wetterslev, M P Wise, M Borthwick, S Bendel, C McArthur, D Cook, N Nielsen, P Pelosi, F Keus, A B Guttormsen, A D Moller, M H Møller
BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries. METHODS: Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects...
May 2015: Acta Anaesthesiologica Scandinavica
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