British Journal of Anaesthesia, 2000, Vol. 84, No. 5 686
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Abstract |
What stress ulcer prophylaxis do you use?
1 Intensive Care Unit, City General Hospital, Stoke-on-Trent, Staffordshire ST4 6QG, UK
Abstract
The subject of stress ulcer prophylaxis has been an area of controversy in critical care medicine, both as to whom should receive prophylaxis and with what agent. Recent evidence has clarified those patients most at risk (respiratory failure and coagulopathy)1 and shown the superiority of H2 antagonists2 at preventing upper gastrointestinal haemorrhage without a significant increase in nosocomial pneumonia. A recent editorial3 has suggested that we not only look at what and when we use prophylaxis, but also its cost effectiveness. We have assessed the current clinical practice in the 24 ITUs within the West Midlands Region.
A point prevalence telephone questionnaire of stress ulcer prophylaxis was carried out. The questions were directed to the senior nursing or medical staff. These were:
(1) Does your unit have a stress ulcer prophylaxis protocol?
(2) If yes, is prophylaxis routine, or do you target high-risk groups?
(3) If no is it left to the individual clinician to make a decision regarding prophylaxis?
(4) What prophylaxis is used?
(5) How many patients are on your unit today?
(6) How many are receiving prophylaxis and what type?
A total of 112 patients were in ITU beds on the day of the study. Fifty-six were receiving prophylaxis, 51 of these were on ranitidine and five were on sucralfate. Two patients were receiving proton pump inhibitors for active gastrointestinal bleeding.
The majority of units had no protocol for the use of stress ulcer prophylaxis. All units with, and most units without, a protocol used ranitidine (Table 33). The use of sucralfate was confined to only two units, which did not have a protocol. Few of the protocol units however targeted their usage of prophylaxis at the high-risk patient. In units without a protocol we were unable to assess whether there was targeted or routine prophylaxis. The majority of units in our region follow best available evidence as regards the type of agent for prophylaxis. Use of ranitidine is more prevalent than in a previous study, 91% vs 46% of units surveyed.4 Units which continue to give ‘blanket’ prophylaxis rather than restrict its use to those at high risk reduce the cost effectiveness of prophylaxis.