Pharmacist-Driven Stress Ulcer Prophylaxis Minimization in the Intensive Care Unit

Launched by METHODIST HEALTH SYSTEM · Jan 16, 2024

Keywords

ClinConnect Summary

Historically, the two independent risk factors for stress-related GI bleeds were coagulopathy and mechanical ventilation for more than 48 hours; however, several additional risk factors have been identified, such as shock, multiple organ failure, traumatic brain injury, and major burns.

Acid suppressive medications such as proton pump inhibitors or histamine-2 receptor antagonists are prescribed to reduce the rate of bleeding from stress ulceration despite a lack of benefit from placebo-controlled trials. In addition to lack of proven benefit, the incidence of clinically significant stress...

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Eligibility criteria

• Inclusion Criteria:
• • Patients ≥18 years ICU location status
• Exclusion Criteria:
• * If patient has one of the following:
• • Coagulopathy (defined as: platelets \< 50,000/µL, international normalized ratio(INR) \> 1.5, or partial thromboplastin time \> 2 times the control value)
• • Mechanical ventilation for \> 48 hours and on \< 50% goal tube feeds
• • Shock state on vasopressors/inotropes and on \< 50% goal tube feeds (or \< 50% of diet)
• • On total parenteral nutrition
• • Use of acid suppressive therapy prior to admission
• • Admission with GI bleeding
• • History of peptic ulcer disease
• • Surgery on the GI tract or cardiac surgery during the current hospital admission
• • Pregnancy
• • H. pylori infection treatment
• • Hypersecretory disorder (ex: Zollinger-Ellison)
• • Known erosive esophagitis/gastritis (not heartburn or gastroesophageal reflux disease)
• • Traumatic brain injury with Glasgow Coma Scale score ≤ 10
• • Major burn (˃30% body surface area)
• • Major trauma requiring ICU admission
• • Spinal cord injury requiring ICU admission
• If patient has two or more of the following:
• • Administration of ˃ 100 mg daily of prednisolone (or equivalent)
• • Sepsis
• • Acute renal failure
• • Acute hepatic failure