title: Stress ulcer prophylaxis in critical illness: a Canadian survey.
abstract: OBJECTIVE
  Stress ulcer prophylaxis (SUP) using histamine-2-receptor antagonists has been a standard of care in intensive care units (ICUs) for four decades. Proton pump inhibitors (PPIs) are increasingly used despite apparently lower background rates of gastrointestinal bleeding and growing concerns about PPI-associated complications. Our objective was to understand the views and prescribing habits amongst Canadian physicians regarding SUP in the ICU and to gauge interest in a future randomized-controlled trial (RCT).
  
  
  METHODS
  We created a short self-administered survey about SUP for critically ill adults, evaluated its clinical sensibility, and pilot tested the instrument. We surveyed all physician members of the Canadian Critical Care Trials Group (CCCTG) by e-mail and sent reminders three and five weeks later.
  
  
  RESULTS
  We received 94 of 111 (85%) surveys from the validated respondent pool between May and June, 2015. Respondents reported use of SUP most commonly in patients 1) receiving invasive mechanical ventilation (62, 66%), 2) expected to be ventilated for ≥ two days (25, 27%), or 3) receiving mechanical ventilation but nil per os (NPO) (20, 21%). Stress ulcer prophylaxis is discontinued when patients no longer receive mechanical ventilation (75%), no longer are NPO (22%), or are discharged from the ICU (19%). Stress ulcer prophylaxis involves PPIs in 68% of centres. Most respondents endorsed the need for a large rigorous RCT of PPI vs placebo to understand the risks and benefits of this practice.
  
  
  CONCLUSIONS
  Stress ulcer prophylaxis is reportedly used primarily for the duration of mechanical ventilation. The CCCTG physicians believe that a placebo-controlled RCT is needed to evaluate the effectiveness and safety of contemporary SUP with PPIs.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Shears
authors.affiliation: Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Waleed
authors.initials: W
authors.lastname: Alhazzani
authors.affiliation: Department of Surgery, Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.affiliation: Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Muscedere
authors.affiliation: Departments of Anesthesia and Critical Care Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Hall
authors.affiliation: Department of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Shane W
authors.initials: SW
authors.lastname: English
authors.affiliation: Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dodek
authors.affiliation: Departments of Medicine, Anesthesiology & Critical Care, Population Health and Optimal Health Practice Research Unit, CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Lauzier
authors.affiliation: Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada.|Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Salmaan
authors.initials: S
authors.lastname: Kanji
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Duffett
authors.affiliation: Department of Pharmacy Practice, Midwestern University, College of Pharmacy-Glendale, Glendale, AZ, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Barletta
authors.affiliation: Department of Emergency and Critical Care, King Fahad Hospital of the University of Dammam, Khobar, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alshahrani
authors.affiliation: Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Arabi
authors.affiliation: Department of Intensive Care, University of Adelaide, Adelaide, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Deane
authors.affiliation: Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Health Sciences Center, Room 2C11, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada. debcook@mcmaster.ca.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
mesh_terms: D000328:Adult; D002170:Canada; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D054328:Proton Pump Inhibitors; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D013312:Stress, Physiological / Q000187:drug effects*; D016896:Treatment Outcome; D014456:Ulcer
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors