Prevention Of Stress Ulcers Research Articles

Practical Comparison of Use of Inj. Ranitidine and Inj. Omeprazole in Peri-Operative Period in Respect to Efficacy and Cost-Effectiveness for Prevention of Stress Ulcers

Practical Comparison of Use of Inj. Ranitidine and Inj. Omeprazole in Peri-Operative Period in Respect to Efficacy and Cost-Effectiveness for Prevention of Stress Ulcers

Application of enteral nutrition in patients with stress ulcer and nursing progress

This article reviews the pathogenesis of stress ulcer, the concept of enteral nutrition and the correlation between the two, and compares and summarizes the timing, preparation, temperature, route and mode of application of enteral nutrition in patients with stress ulcer, and summarizes the main points in nursing for enteral nutrition, in order to provide a theoretical basis for clinical medical staff to develop individualized enteral nutrition intervention programs to effectively prevent stress ulcers. Key words: Review; Enteral nutrition; Prevention; Treatment; Stress ulcer

Epidemiology of mechanically ventilated patients treated in ICU and non-ICU settings in Japan: a retrospective database study

BackgroundIn most countries, patients receiving mechanical ventilation (MV) are treated in intensive care units (ICUs). However, in some countries, including Japan, many patients on MV are not treated in ICUs. There are insufficient epidemiological data on these patients. Here, we sought to describe the epidemiology of patients on MV in Japan by comparing and contrasting patients on MV treated in ICUs and in non-ICU settings. A preliminary comparison of patient outcomes between ICU and non-ICU patients was a secondary objective.MethodsData on adult patients receiving MV for at least 3 days in ICUs or non-ICU settings from April 2010 through March 2012 were obtained from the Quality Indicator/Improvement Project, a voluntary data-administration project covering more than 400 acute-care hospitals in Japan. We excluded patients with cancer-related diagnoses. Patient demographic data and the critical care provided were compared between groups.ResultsOver the study period, 17,775 patients on MV were treated only in non-ICU settings, whereas 20,516 patients were treated at least once in ICUs (46.4% vs. 53.6%). Average age was higher in non-ICU patients than in ICU patients (72.8 vs. 70.2, P < 0.001). Mean number of ventilation days was greater in non-ICU patients (11.7 vs. 9.5, P < 0.001). Hospital mortality was higher in non-ICU patients (41.4% vs. 38.8%, P < 0.001). Standard critical care (e.g., arterial line placement, enteral nutrition, and stress-ulcer prevention) was provided significantly less often in non-ICU patients. Multivariate analysis showed that ICU admission significantly decreased hospital mortality (adjusted odds ratio 0.713, 95% CI 0.676 to 0.753).ConclusionsA large proportion of Japanese patients on MV were treated in non-ICU settings. Analysis of administrative data indicated preliminarily that hospital mortality rates in these patients were higher in non-ICU settings than in ICUs. Prospective analyses comparing non-ICU and ICU patients on MV by severity scoring are needed.

How important are proton pump inhibitors in the prevention of stress ulcers and stress-associated gastrointestinal bleeding in ICU patients?

How important are proton pump inhibitors in the prevention of stress ulcers and stress-associated gastrointestinal bleeding in ICU patients?

The risks of long-term use of proton pump inhibitors: a critical review.

Proton pump inhibitors (PPIs) are among the most frequently prescribed medications. Their use is likely even higher than estimated due to an increase in the number of PPIs available without a prescription. Appropriate indications for PPI use include Helicobacter pylori infection, erosive esophagitis, gastric ulcers, and stress ulcer prevention in high-risk critically ill patients. Unfortunately, PPIs are often used off-label for extended periods of time. This increase in PPI usage over the past two decades has called into question the long-term effects of these medications. The association between PPI use and infection, particularly Clostridium difficile and pneumonia, has been the subject of several studies. It’s proposed that the alteration in gastrointestinal microflora by PPIs produces an environment conducive to development of these types of infections. At least one study has suggested that long-term PPI use increases the risk of dementia. Drug interactions are an important and often overlooked consideration when prescribing any medication. The potential interaction between PPIs and antiplatelet agents has been the subject of multiple studies. One of the more recent concerns with PPI use is their role in the development or progression of chronic kidney disease. There is also some literature suggesting that PPIs contribute to the development of various micronutrient deficiencies. Most of the literature examining the potential adverse effects of PPI use is composed of retrospective, observation studies. There is a need for higher quality studies exploring this relationship.

Intensive care unit prophylaxis and its outcome in a rural tertiary care hospital: an observational study

Background: Intensive Care Unit is used to treat patients closer to their beds, in order to observe them more as distinct people to almost all the critically-ill patients.Methods: One hundred admitted patients in the ICU, 25 each sets of the patients observed their prophylactic management to prevent stress ulcer, pressure ulcer, UTI and chest infection, observations noted for the 7 days, directly by seeing and by cross-checked patient’s case-sheets.Results: There were 2 (8%) patients developed stress ulcer, 1 (4%) Catheter associated bacteriuria, 2 (8%) patients grade II pressure ulcer, and 5 (20%) patient’s done endotracheal intubation. All these 5 (20%) report of sputum culture found Ps. Aeruginosa, Klebsiella sensitive for Ceftriaxone + Sulbactum. The standard nursing care done by the on duty nursing staffs, i.e., no one given Ryle’s tube feeding for the stress ulcer cases, advised soft, palatable, non-spicy oral diet, Pressure ulcer’s 8% patients shifted on the air-bed mattress, ulcer’s cleaned with normal water soaked soft-napkin and applied sterile pad compressed dressing locally. For the ventilator in-situ patient’s, endotracheal tube cleaned 8-12 times within 12 hours. The Inbuilt Ventilator tube cleaned, and its filter changed and kept ready by the following standard aseptic precaution before using the ventilator. The chest physiotherapy was done by the chest medicine specialist of the all 5 ventilated patients. Prophylactic medication provided, i.e., Injection Pantoprazole 40mg once daily, Injection Ciprofloxacin 400mg twice daily, and Injection Inj. Ceftriaxone + Sulbactum gm 12 hourly interval administered daily.Conclusions: From this study, we can conclude that Gentamicin is more nephrotoxic and causes greater fall in creatinine clearance although the dose of Gentamicin administered is much lower compared to Amikacin.

Effectiveness differences of ranitidine and omeprazole in prevention of stress ulcer and its effect on pneumonia occurrence and outcome of acute stroke patients

Stress ulcer is one ofacute stroke complications. Giving ranitidine or omeprazole may prevent stress ulcer, but may increase the occurrence of pneumonia. Thus, it will affect the outcome of acute stroke. The method was experimental with a randomized control-group pretest - posttest design. This study divided the subjects into two groups, ranitidine 300mg and omeprazole 20mg group.We observed the patients whether stress ulcer or pneumonia occurred during hospitalization. Then, we measured the outcome by the National Institutes of Health Stroke Scaleand modified Rankin Scale. There were 32 subjects in this study. Only 1 (3.1%) subject suffered stress ulcer, and 3 (3.1%) suffered pneumonia in ranitidine group. Moreover, 2 (6.2%) subjects suffered pneumonia in omeprazole group. The differences were not significant between the two groups (p = 0.31 and p = 0.54). There was no significant effect and difference effect on the administration of both medications to the outcome at day 14. These results indicate that ranitidine and omeprazole have anequal effectiveness in the prevention of stress ulcer and also have equal effect on the occurrence of pneumonia, and both have no effect on the outcome of acute stroke patients.

How effective is stress ulcer prevention for critically ill, hospitalized patients?

EVIDENCE-BASED ANSWER For critically ill hospitalized patients, stress ulcer prophylaxis with proton-pump inhibitors (PPIs) or histamine 2 (H2) receptor blockers reduces the incidence of upper gastrointestinal (GI) bleeding up to 56% compared with placebo or no treatment (SOR: A, metaanalysis of RCTs). Evidence is conflicting if PPIs are more effective than H2 blockers. No significant difference was noted in mortality or pneumonia rates in patients treated with PPI or H2 blockers versus placebo or no treatment (SOR: A, 2 meta-analyses, single RCT).

Glutamine combined with pantoprazole for prevention of stress ulcer in patients with thalamic hemorrhage: Impact on prognosis

Glutamine combined with pantoprazole for prevention of stress ulcer in patients with thalamic hemorrhage: Impact on prognosis

Quality Improvement in the Trauma Intensive Care Unit Using a Rounding Checklist: The Implementation Results

Purpose: Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated. Methods: A checklist consisting of 12 components (feeding, analgesia, sedation, throm boembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium mon itoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period. Results: Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3. Conclusions: An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.

Effect of lowering the temperature of enteral nutrition on prevention of stress ulcer in patients with severe craniocerebral injury

Objective To probe into the efficacy and safety of lowering the temperatures of enteral nutrition in severe craniocerebral injury patients to prevent stress ulcer, and provide reference for patients with severe craniocerebral injury to choose appropriate enteral nutrition temperature. Methods The clinical randomized controlled trial was adopted. Numbered the patients by the order of being hospitalized, then divided the 84 patients with severe craniocerebral injury who were receiving enteral nutrition into experimental group and control group with 42 cases each. The constant temperature in experimental group was 22 ℃, and that in control group was 38 ℃. Observed and compared regularly the pH levels, occult blood test of gastric juice and defecate of the two groups within 7 days. Results After different temperature enteral nutrition, pH value of gastric juice of patients at 1, 4, 7 days after enteral nutrition was 2.610.37, 4.550.35, 4.870.34 in experimental group, 2.210.44, 3.930.22, 4.180.30 in control group, there was significant difference between two groups (t=3.856, 8.185, 8.322, all P 0.05). There was no significant difference in the incidence of diarrhea and diarrhea start time between two groups (χ2=0.288, t=0.372, all P>0.05). Conclusions Lowering the temperature of enteral nutrition has a certain protective effect on the gastric mucosa of patients with severe craniocerebral injury, which is helpful to prevent the occurrence of stress ulcer, and does not increase the risk of diarrhea. Key words: Temperature; Craniocerebral trauma; Enteral nutrition; Stress ulcer

Pediatric intensive care stress ulcer prevention (PIC-UP): a protocol for a pilot randomized trial

BackgroundDespite 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. The objective of this pilot RCT is to assess the feasibility of a large multicentre RCT of stress ulcer prophylaxis with pantoprazole to prevent upper GI bleeding vs. placebo.MethodsA multi-centre blinded pilot RCT of 120 children in six Canadian PICUs. Children expected to require mechanical ventilation for more than 48 h will be randomized to receive intravenous pantoprazole 1 mg/kg or identical placebo once daily until they no longer need mechanical ventilation. We have four feasibility outcomes and will consider the trial successful if we achieve:Effective screening: If >80% of eligible patients are approached for consent.Timely enrollment: if >80% of participants receive their first dose of the assigned study drug within 1 day of becoming eligible.Participant accrual: If the average monthly enrolment is two or more participants per centre per month.Protocol adherence: if >90% of doses are administered according to the protocol.DiscussionThere are many uncertainties about the risks and benefits of stress ulcer prophylaxis. In an era of widespread use—where clinicians prescribe prophylaxis to the more severely ill—a large, rigorous RCT is required. A trial to determine if a strategy of withholding stress ulcer prophylaxis is not inferior to a strategy of routine stress ulcer prophylaxis will be challenging. A carefully designed and implemented pilot trial is essential.Trial registrationClinicalTrials.gov:NCT02929563 (Registered October 3, 2016).

Comparison of the Hospital-Acquired Clostridium difficile Infection Risk of Using Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists for Prophylaxis and Treatment of Stress Ulcers: A Systematic Review and Meta-Analysis.

Background/AimsAlthough proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs.MethodsA systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I2, and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence.ResultsA total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I2=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low.ConclusionsThe use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.

Prophylaxis for Stress Ulcers With Proton Pump Inhibitors Is Not Associated With Increased Risk of Bloodstream Infections in the Intensive Care Unit

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. 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. The primary exposure was PPI use for stress ulcer prophylaxis in the ICU. The primary outcome was BSI, confirmed by culture analysis, arising 48 hours or more after admission to the ICU. Subjects were followed for 30 days after ICU admission or until death, discharge, or BSI. Multivariable Cox proportional hazards modeling was used to test the association between PPIs and BSI after controlling for patient comorbidities and other clinical factors. We analyzed data from 24,774 patients in the ICU, including 756 patients (3.1%) who developed BSIs while in the ICU. The cumulative incidence of BSI was 3.7% in patients with PPI exposure compared with 2.2% in patients without PPI exposure (log-rank test, P < .01). After adjusting for potential confounders, PPI exposure was not associated with increased risk of BSI while in the ICU (adjusted hazard ratio, 1.08; 95% confidence interval, 0.91-1.29). Comorbidities, antibiotic use, and mechanical ventilation were all independently associated with increased risk for BSIs. In a retrospective study of patients in the ICU, administration of PPIs to prevent bleeding was not associated with increased risk of BSI. These findings indicate that concern for BSI should not affect decisions regarding use of PPIs in the ICU.

Early enteral nutrition combined with omeprazole for prevention of stress ulcer in patients with cerebral apoplexy

Early enteral nutrition combined with omeprazole for prevention of stress ulcer in patients with cerebral apoplexy

Prophylactic proton pump inhibitors in femoral neck fracture patients - A life - and cost-saving intervention.

Introduction Acute gastrointestinal stress ulceration is a common and serious complication of trauma. Prophylactic proton pump inhibitors (PPIs) or histamine receptor antagonists have been used in poly-trauma, burns and head and spinal injuries, as well as on intensive care units, for the prevention of acute gastric stress ulcers. Methods We prospectively studied the use of prophylactic PPIs in with femoral neck fracture patients, gathering data on all acute gastric ulcer complications, including coffee-ground vomiting, malena and haematemesis. We then implemented a treatment protocol in which all patients were given prophylactic PPIs, again prospectively collecting all data. Results Five hundred and fifteen patients were included. Prior to prophylactic PPI, 15% of patients developed gastric stress ulcer complications, with 3% requiring acute intervention with oesophagogastroduodenoscopy (OGD), 5% requiring transfusions and 4% experiencing surgical delays. All patients had delayed discharges. Following PPI implementation, no patients developed gastric stress ulcer complications. Conclusions Femoral neck fracture patients create a substantial workload for orthopaedic units. The increasingly elderly population often have comorbidities, and concomitantly use medications with gastrointestinal side effects. This, combined with the stress of a fracture and preoperative starvation periods increases the risk of gastric ulcers. Here, the use of prophylactic PPIs statistically reduced the incidence of gastric stress ulcers in patients with femoral neck fractures, resulting in fewer surgical delays, reduced length of hospital stay and reduced stress ulcer-related mortality.

Off-label and unlicensed utilisation of medicines in a French paediatric hospital.

Off-label or unlicensed medicine use is very common in paediatric practice, ranging from 11 to 80 %, and is one of the predisposing factors for adverse events (23-60 %). Medicine indications are the third leading reason for doctors to perform off-label prescriptions. The aim of our study was to determine the prevalence and nature of off-label and unlicensed medicine prescriptions in children and propose methods for risk reduction and management. 475 bed maternity-paediatric university hospital. Retrospective cross-sectional study lasting 1 day on new prescriptions issued over the previous 24 h by departments using electronic prescribing. Age and indication were compared to those in the French independent formulary Thériaque(®) database. Number of off-label/unlicensed prescriptions, number of patients, proportion of off-label/unlicensed prescriptions by age group, treatment class and International Non proprietary Name (INN), using the established classification. A total of 315 prescription medicines were analysed for 120 patients, of average age 5.1 years old. For the classification of medicine utilisation, the majority of the medicines were prescribed as licensed (190/60.3 %), followed by off-label (115/36.5 %) and unlicensed (10/3.2 %) medicines. Alimentary tract, metabolic and nervous system medicines constituted the most widely prescribed ATC classes. At least 54 % of patients received an off-label/unlicensed medicine. The indications for these were mainly for off-label prescriptions (80/25.4 %) followed by medicines not evaluated for safety and regarding safety and efficacy in children (14/4.5 %). Pantoprazole was the most widely prescribed off-label INN for stress ulcer prevention (62 %). For risk reduction, we found esomeprazole being prescribed instead of pantoprazole; esomeprazole is indicated for children under a year old. This study reflects one given day: 36.5 % of off-label prescriptions and 3.2 % of unlicensed prescriptions in a paediatric setting. Few risk reductions for off-label number prescriptions have been found. This work confirmed the necessity of carrying out further studies in children.

English

English

Rapport sur l’utilisation des inhibiteurs de la pompe à protons : les recommandations françaises sont-elles respectées ?

PurposeIn June 2009, the national French authority for Health reported many off-label uses of proton pump inhibitors (PPI). Our objective was to analyse the justification and modalities of PPI prescriptions in patients before their admission in a department of internal medicine. MethodsData were prospectively collected during 5months. At admission, all prescriptions of PPI by general practitioners (GP) were recorded. The accordance of the prescriptions with the marketing authorization indications and the French guidelines in terms of duration of treatment or dosage was analyzed. These informations were obtained from computerized medical records and, if necessary, by contacting GPs. ResultsWe collected 173 prescriptions. Fifty-six (32%) were in accordance with marketing authorization indications and, among them, 15 prescriptions (9% of all) respected the French guidelines about dosage and duration of treatment. One hundred and six prescriptions (61%) were not adequate and among them an off-label use was notified in 91 (53% of all); among them 33% for simple dyspeptic disorders, 23% for the prevention of NSAID-induced lesions in patients without risk factors, and finally 17% for the prevention of stress ulcer. Fifty-two prescriptions (30%) were unclassified due to incomplete data. ConclusionOur study showed that a vast majority of the prescriptions for PPIs are not in accordance with French guidelines. Preventive actions against abusive prescriptions, withdrawal strategies or replacement of already prescribed PPIs should be implemented to reduce the risk of side effects and the economic impact of long term use of PPIs.

Pantoprazole for prevention of post-traumatic stress ulcer

Pantoprazole for prevention of post-traumatic stress ulcer