Abstract
ABSTRACT Background:The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. Aim:To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. Methods:Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. Results:One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). Conclusion:The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.
Highlights
In 1935 Hans Selye, based on experimentation on rats, observed what he called “general adaptation syndrome”, which occurred when the organism suffered acute and severe damage by a non-specific agent and which, in its first stage (6-48 h), one of the manifestations was the formation of acute erosions of the digestive tract[8]
In critically ill patients hospitalized for acute illness, only those most at risk for gastrointestinal bleeding for stress ulcer (GIBSU) have an indication for pharmacoprophylaxis[10]
The aim of this study was to determine the appropriateness of the use of prophylaxis for GIBSU in acutely ill patients admitted to intensive care units (ICU) and to analyze the association of risk factors with adherence to prophylaxis for GIBSU
Summary
In 1935 Hans Selye, based on experimentation on rats, observed what he called “general adaptation syndrome”, which occurred when the organism suffered acute and severe damage by a non-specific agent and which, in its first stage (6-48 h), one of the manifestations was the formation of acute erosions of the digestive tract[8]. Acute gastric mucosal damage (stress ulcer) or bleeding from stress ulcer may occur. With the observation of this occurrence, the practice of using pharmacological agents for the prevention of gastrointestinal bleeding for stress ulcer (GIBSU) in critical patients has become widespread. Such use has risks and, should be indicated in patients with an adequate risk-benefit profile. The aim of this study was to determine the appropriateness of the use of prophylaxis for GIBSU in acutely ill patients admitted to intensive care units (ICU) and to analyze the association of risk factors with adherence to prophylaxis for GIBSU
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