Stress Ulcer Prophylaxis in Neurocritical Care

Overview

Journal Neurocrit Care

Specialty Critical Care

Date 2017 Sep 21

PMID 28929324

Citations 3

Authors

Jeffrey F Barletta

Alicia J Mangram

Joseph F Sucher

Victor Zach

Affiliations

Soon will be listed here.

Abstract

Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today's standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse. This narrative review will discuss current controversies with SUP as they apply to neurocritical care patients. Specifically, the pathophysiology, prevalence, and risk factors for CIB along with the comparative efficacy, safety, and cost-effectiveness of acid-suppressive therapy will be described.

Citing Articles

Stressing over ulcer prophylaxis in the neurocritical trauma patient.

Topper G, Patel P, Egodage T Trauma Surg Acute Care Open. 2024; 9(1):e001418.

PMID: 38450047 PMC: 10916095. DOI: 10.1136/tsaco-2024-001418.

A Nomogram for Individualized Prediction of Stress-Related Gastrointestinal Bleeding in Critically Ill Patients with Primary Intracerebral Hemorrhage.

Liu S, Wang Y, Gao B, Peng J Neuropsychiatr Dis Treat. 2022; 18:221-229.

PMID: 35177906 PMC: 8843804. DOI: 10.2147/NDT.S342861.

Audit on Practices of Stress Ulcer Prophylaxis in Intensive Care Unit Patients.

Gupta D, Bhalotra A, Singh R Indian J Crit Care Med. 2020; 24(3):160-167.

PMID: 32435093 PMC: 7225769. DOI: 10.5005/jp-journals-10071-23368.

References

Barkun A, Adam V, Martel M, Bardou M . Cost-effectiveness analysis: stress ulcer bleeding prophylaxis with proton pump inhibitors, H2 receptor antagonists. Value Health. 2013; 16(1):14-22. DOI: 10.1016/j.jval.2012.08.2213. View

Metz C, Livingston D, Smith J, Larson G, Wilson T . Impact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding: a prospective, multicenter, double-blind, randomized trial. The Ranitidine Head Injury Study Group. Crit Care Med. 1993; 21(12):1844-9. DOI: 10.1097/00003246-199312000-00010. View

Ran L, Khatibi N, Qin X, Zhang J . Proton pump inhibitor prophylaxis increases the risk of nosocomial pneumonia in patients with an intracerebral hemorrhagic stroke. Acta Neurochir Suppl. 2011; 111:435-9. DOI: 10.1007/978-3-7091-0693-8_75. View

Buendgens L, Bruensing J, Matthes M, Duckers H, Luedde T, Trautwein C . Administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile-associated diarrhea. J Crit Care. 2014; 29(4):696.e11-5. DOI: 10.1016/j.jcrc.2014.03.002. View

Chan K, Mann K, Lai E, Ngan J, Tuen H, Yue C . Factors influencing the development of gastrointestinal complications after neurosurgery: results of multivariate analysis. Neurosurgery. 1989; 25(3):378-82. DOI: 10.1097/00006123-198909000-00010. View

Faisy C, Guerot E, Diehl J, Iftimovici E, Fagon J . Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Intensive Care Med. 2003; 29(8):1306-13. DOI: 10.1007/s00134-003-1863-3. View

Hatton J, Lu W, Rhoney D, Tibbs P, Dempsey R, Young B . A step-wise protocol for stress ulcer prophylaxis in the neurosurgical intensive care unit. Surg Neurol. 1996; 46(5):493-9. DOI: 10.1016/s0090-3019(96)00245-5. View

Bashar F, Manuchehrian N, Mahmoudabadi M, Hajiesmaeili M, Torabian S . Effects of ranitidine and pantoprazole on ventilator-associated pneumonia: a randomized double-blind clinical trial. Tanaffos. 2014; 12(2):16-21. PMC: 4153243. View

Chan K, Lai E, Tuen H, Ngan J, Mok F, Fan Y . Prospective double-blind placebo-controlled randomized trial on the use of ranitidine in preventing postoperative gastroduodenal complications in high-risk neurosurgical patients. J Neurosurg. 1995; 82(3):413-7. DOI: 10.3171/jns.1995.82.3.0413. View

10.

Conrad S, Gabrielli A, Margolis B, Quartin A, Hata J, Frank W . Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Crit Care Med. 2005; 33(4):760-5. DOI: 10.1097/01.ccm.0000157751.92249.32. View

11.

Shaughnessy M, Micielli R, DePestel D, Arndt J, Strachan C, Welch K . Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol. 2011; 32(3):201-6. DOI: 10.1086/658669. View

12.

Howell M, Novack V, Grgurich P, Soulliard D, Novack L, Pencina M . Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med. 2010; 170(9):784-90. DOI: 10.1001/archinternmed.2010.89. View

13.

Beaulieu M, Williamson D, Pichette G, Lachaine J . Risk of Clostridium difficile-associated disease among patients receiving proton-pump inhibitors in a Quebec medical intensive care unit. Infect Control Hosp Epidemiol. 2007; 28(11):1305-7. DOI: 10.1086/521664. View

14.

Williamson D, Albert M, Heels-Ansdell D, Arnold D, Lauzier F, Zarychanski R . Thrombocytopenia in critically ill patients receiving thromboprophylaxis: frequency, risk factors, and outcomes. Chest. 2013; 144(4):1207-1215. DOI: 10.1378/chest.13-0121. View

15.

ELLISON R, Perez-Perez G, Welsh C, Blaser M, Riester K, Cross A . Risk factors for upper gastrointestinal bleeding in intensive care unit patients: role of helicobacter pylori. Federal Hyperimmune Immunoglobulin Therapy Study Group. Crit Care Med. 1996; 24(12):1974-81. DOI: 10.1097/00003246-199612000-00008. View

16.

Stevens V, Dumyati G, Brown J, Wijngaarden E . Differential risk of Clostridium difficile infection with proton pump inhibitor use by level of antibiotic exposure. Pharmacoepidemiol Drug Saf. 2011; 20(10):1035-42. DOI: 10.1002/pds.2198. View

17.

Wade E, Rebuck J, Healey M, Rogers F . H(2) antagonist-induced thrombocytopenia: is this a real phenomenon?. Intensive Care Med. 2002; 28(4):459-65. DOI: 10.1007/s00134-002-1233-6. View

18.

Cawley M, Wittbrodt E, Boyce E, Skaar D . Potential risk factors associated with thrombocytopenia in a surgical intensive care unit. Pharmacotherapy. 1999; 19(1):108-13. DOI: 10.1592/phco.19.1.108.30518. View

19.

Alhazzani W, Alenezi F, Jaeschke R, Moayyedi P, Cook D . Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2013; 41(3):693-705. DOI: 10.1097/CCM.0b013e3182758734. View

20.

Gratrix A, Enright S, OBeirne H . A survey of stress ulcer prophylaxis in Intensive Care Units in the UK. Anaesthesia. 2007; 62(4):421-2. DOI: 10.1111/j.1365-2044.2007.05050.x. View