Overuse of stress ulcer prophylaxis in the critical care setting and beyond.
BACKGROUND
Patients admitted to the intensive care unit (ICU) are susceptible to stress ulcers. We hypothesize that despite recommendations, stress ulcer prophylaxis (SUP) is still overused in the ICU and often continued after resolution of risk factors for bleeding.


METHODS
We retrospectively studied all ICU admissions for 4 months. Risk factors for stress ulcer bleeding were collected. Patients were categorized into 4 groups: (1) >or=1 major risk factor; (2) >or=1 minor risk factors; (3) no risk factors; (4) preadmission use of acid-suppressive medication. The rate of SUP was calculated by group during ICU stay, on transfer from the ICU, and at hospital discharge.


RESULTS
Two hundred ten patients were studied. Of all the ICU admissions, 87.1% received SUP. Among patients with no risk factors, 68.1% were placed on prophylaxis on ICU admission; 60.4% continued on treatment upon transfer from the ICU; 31.0% were discharged home on an agent without a new indication.


CONCLUSIONS
Although judicious use of SUP in high-risk patients can decrease the incidence of gastrointestinal bleeding, inappropriate use may increase drug reactions, unnecessary hospital costs, and personal monetary burden. Our findings argue for improvement measures to reduce initial inpatient overuse of SUP and to prompt discontinuation before hospital discharge.
Farrell
Christopher P
CP
Department of Internal Medicine Residency Program, Annenberg Conference Center, Lankenau Hospital, Wynnewood, PA 19096, USA. cfarrell22@hotmail.com
Mercogliano
Giancarlo
G
Kuntz
Catherine L
CL
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000209:etiology / Q000517:prevention & control*; D013315:Stress, Psychological / Q000150:complications; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
D000897:Anti-Ulcer Agents