title: Opinions and practice of stress ulcer prophylaxis in Australian and New Zealand intensive care units.
abstract: BACKGROUND
  Intensivists frequently prescribe proton pump inhibitors (PPIs) or histamine-2 receptor blockers (H2RBs) to intensive care unit patients for stress ulcer prophylaxis (SUP). Despite the common use of SUP medicines, there is limited high-level evidence to support the choice between them.
  
  
  OBJECTIVE
  To describe self-reported practice of SUP by Australian and New Zealand intensivists.
  
  
  METHODS
  An online questionnaire of intensivists between 13 January and 3 February 2014.
  
  
  RESULTS
  Seventy-two intensivists responded to the survey: 61 (85%) practised in public metropolitan ICUs and 13/48 (27%) practised in paediatric ICUs. Fifty-two (72%) respondents indicated that PPIs were their preferred SUP medicine. Respondents estimated that an average of 84% of ventilated and 53% of non-ventilated patients received SUP medicines during their ICU admission. Seven respondents (9%) were concerned or very concerned about the possible increased risk of upper gastrointestinal bleeding associated with H2RBs versus PPIs. Ten respondents (14%) were concerned or very concerned about the possible greater risk of Clostridium difficile infection, and 15 respondents (21%) were concerned or very concerned about the possible greater risk or ventilator-associated pneumonia with PPIs versus H2RBs. Most respondents (64 [89%]) agreed or strongly agreed that there was insufficient evidence to support the choice of an optimal SUP medicine, and 58 respondents (81%) agreed or strongly agreed to patient enrollment in an RCT comparing PPIs with H2RBs.
  
  
  CONCLUSIONS
  Most survey respondents felt that current evidence is insufficient to justify the preferential use of PPIs or H2RBs for SUP and would enroll patients in a comparative SUP RCT.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. glenn.eastwood@austin.org.au.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.affiliation: Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia.
authors.forename: Ed
authors.initials: E
authors.lastname: Litton
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Melbourne, VIC, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bailey
authors.affiliation: Department of Intensive Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Mario
authors.initials: M
authors.lastname: Festa
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Beasley
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Young
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D016360:Clostridioides difficile; D003422:Critical Care; D003625:Data Collection; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced; D006635:Histamine H2 Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D009520:New Zealand; D010437:Peptic Ulcer / Q000517:prevention & control*; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors