Survey of stress ulcer prophylaxis

Three hundred sixty-eight surveys were sent to all members of theSection of Pharmacy and Pharmacology of the Society of Critical Care Medicine.One hundred fifty-three (42%) surveys were returned. Representatives from 86%of institutions stated that medications for stress ulcer prophylaxis are usedin a majority (>90%) of patients admitted to the intensive care unit (ICU).Twenty-two per cent of institutions have recommendations for both ICU andnon-ICU settings. Fifty-eight per cent of institutions stated that there wasone preferred medication for stress ulcer prophylaxis, and in 77% of thesehistamine-2-antagonists were the most popular.There are wide variations in prescribing practices for stressulcer prophylaxis. Institutions should consult published literature and usepre-existing guidelines as templates for developing their own guidelines.Stress-induced gastroduodenal erosions are a frequent occurrence in critically ill patients, but it is the incidence of clinically important complications resulting from these erosions that is important in deciding which patients should receive prophylaxis. Clinically important complications include bleeding that requires transfusion, bleeding associated with hemodynamic instability, and gastrointestinal perforations. Failure to document these complications in published studies limits the conclusions that can be drawn from much of the available literature. There have been inconsistent results in those studies that did record clinically important bleeding, depending on severity of illness or injury, and concomitant or underlying disease states.Because the results of clinical investigations have led to different recommendations concerning stress ulcer prophylaxis, Cook et al [1] performed a meta-analysis of randomized trials to resolve the controversies associated with previous research in this area. They concluded that there was no clear agent of choice for prophylaxis based on efficacy considerations (ie ability to prevent clinicall