title: A survey of prescriber perceptions about the prevention of stress-related mucosal bleeding in the intensive care unit.
abstract: OBJECTIVE
  Practices vary between institutions and amongst prescribers regarding when to initiate stress ulcer prophylaxis (SUP), which agent to choose (including doses and frequencies) and rationale, and decisions about escalation or discontinuation of therapy. The purpose of this survey is to evaluate the perceptions of prescribers about risk assessment of stress-related mucosal bleeding (SRMB) and practice patterns of SUP.
  
  
  METHODS
  A cross-sectional survey of 800 US critical care prescribers using the membership of the Society of Critical Care Medicine. The levels of agreement with specific statements were rated on a nine-point Likert scale.
  
  
  RESULTS
  Of 712 eligible recipients, 245 (34·4%) completed the questionnaire. Respondents were primarily attending physicians (81·2%) working in adult medical or surgical (59·2%) intensive care units. Mucosal ischaemia was identified as the pathophysiological cause of SRMB by 110 (44·9%) respondents. Respondents agreed that risk factors for SRMB were acute hepatic failure, anticoagulant use, burns >35%, coagulopathy, absence of enteral feeding, recent gastroduodenal ulcer, corticosteroid use, Helicobacter pylori infection, neurologic injury, trauma, NSAID use, mechanical ventilation, shock and sepsis. Histamine subtype 2 receptor antagonists (58·4%) and proton pump inhibitors (39·6%) were the most frequently chosen agents. No consensus was reached about whether either class is associated with clostridium difficile infection or nosocomial pneumonia. Reasons to discontinue therapy included clinically improved patient status (73·1%), extubation (68·2%), reversal of 'nil-by-mouth' (68·6%) and transfer to a non-ICU setting (67·8%).
  
  
  CONCLUSIONS
  Considerable variability exists in the perceptions surrounding risk factors for SRMB and prescribing patterns for SUP therapy likely because limited or conflicting data are available addressing these issues. Opportunities exist to educate prescribers and conduct research about the pathologic cause and risk factors for SRMB, the preferred class of agents, and the appropriate discontinuation of therapy.
authors.affiliation: Department of Pharmacy, Denver Health Medical Center, Denver, CO, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Preslaski
authors.forename: S W
authors.initials: SW
authors.lastname: Mueller
authors.forename: T H
authors.initials: TH
authors.lastname: Kiser
authors.forename: D N
authors.initials: DN
authors.lastname: Fish
authors.forename: R
authors.initials: R
authors.lastname: MacLaren
mesh_terms: D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000379:methods; D003430:Cross-Sectional Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D013312:Stress, Physiological; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States
chemical_list: D000897:Anti-Ulcer Agents
keywords: clostridium difficile; critical care; histamine antagonist; pneumonia; proton pump inhibitor; risk factors; stress ulcer; survey