Advertisement

Intensive Care Medicine

, Volume 43, Issue 8, pp 1132–1134 | Cite as

What’s new with stress ulcer prophylaxis in the ICU?

  • Søren Marker
  • Mette Krag
  • Morten Hylander MøllerEmail author
What's New in Intensive Care

What is known?

Critically ill patients are at risk of stress-related mucosal erosions [1]. These are typically superficial and asymptomatic but may progress to ulceration and overt and clinically important gastrointestinal (GI) bleeding, a serious condition associated with increased morbidity and mortality [2]. The reported incidence of GI bleeding varies between 2 and 5% [3, 4], probably because of heterogeneous populations, varying definitions of GI bleeding, and difficulties in diagnosing stress ulcers [3, 4]. Importantly, stress ulcerations have been identified as the sole source of GI bleeding by endoscopy in fewer than 50% of patients with GI bleeding [5]. A number of risk factors for stress ulcer-related bleedings have been suggested, including mechanical ventilation, coagulopathy, acute kidney injury, hepatic failure, and disease severity [2, 3, 4, 6]. A protective effect of enteral nutrition has been proposed [1], however this has not been confirmed in subsequent studies [6].

I...

Keywords

Intensive Care Unit Intensive Care Unit Patient Clostridium Difficile Infection Lansoprazole Pantoprazole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflicts of interest

The authors are members of the Steering Committee of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial. The authors declare no other conflicts of interest.

References

  1. 1.
    Marik PE, Vasu T, Hirani A, Pachinburavan M (2010) Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med 38:2222–2228CrossRefPubMedGoogle Scholar
  2. 2.
    Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R et al (1994) Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 330:377–381CrossRefPubMedGoogle Scholar
  3. 3.
    Krag M, Perner A, Wetterslev J, Wise MP, Borthwick M, Bendel S et al (2015) Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Med 41:833–845CrossRefPubMedGoogle Scholar
  4. 4.
    MacLaren R, Reynolds PM, Allen RR (2014) Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit. JAMA Intern Med 174:564–574CrossRefPubMedGoogle Scholar
  5. 5.
    Cook D, Heyland D, Griffith L, Cook R, Marshall J, Pagliarello J (1999) Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. Crit Care Med 27:2812–2817CrossRefPubMedGoogle Scholar
  6. 6.
    Krag M, Perner A, Wetterslev J, Wise MP, Hylander Møller M (2014) Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Intensive Care Med 40:11–22CrossRefPubMedGoogle Scholar
  7. 7.
    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al (2017) Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. doi: 10.1007/s00134-017-4683-6. (Epub ahead of print)
  8. 8.
    Alshamsi F, Belley-Cote E, Cook D, Almenawer SA, Alqahtani Z, Perri D et al (2016) Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials. Crit Care 20:120CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Charlot M, Ahlehoff O, Norgaard ML, et al. (2010) Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study. Ann Intern Med 153:378–386CrossRefPubMedGoogle Scholar
  10. 10.
    Faleck DM, Salmasian H, Furuya EY, Larson EL, Abrams JA, Freedberg DE (2016) Proton pump inhibitors do not increase risk for Clostridium difficile infection in the intensive care unit. Am J Gastroenterol 111:1–8CrossRefGoogle Scholar
  11. 11.
    Karanika S, Paudel S, Zervou FN, Grigoras C, Zacharioudakis IM, Mylonakis E (2015) Prevalence and clinical outcomes of Clostridium difficile infection in the intensive care unit: a systematic review and meta-analysis. Open Forum Infect Dis 3:ovf86Google Scholar
  12. 12.
    Sehested TS, Fosbøl EL, Hansen PW, Charlot MG, Torp-Pedersen C, Gislason GH (2016) Abstract 18462: proton pump inhibitor use increases the associated risk of first-time ischemic stroke. A Nationwide Cohort Study. Circulation 134:A18462Google Scholar
  13. 13.
    Farley KJ, Barned KL, Crozier TM (2013) Inappropriate continuation of stress ulcer prophylaxis beyond the intensive care setting. Crit Care Resusc 15:147–151PubMedGoogle Scholar
  14. 14.
    Selvanderan SP, Summers MJ, Finnis ME, Plummer MP, Ali Abdelhamid Y, Anderson MB et al (2016) Pantoprazole or Placebo for Stress Ulcer Prophylaxis (POP-UP). Crit Care Med 44:1842–1850CrossRefPubMedGoogle Scholar
  15. 15.
    Lin C-C, Hsu Y-L, Chung C-S, Lee T-H (2016) Stress ulcer prophylaxis in patients being weaned from the ventilator in a respiratory care center: a randomized control trial. J Formos Med Assoc 115:19–24CrossRefPubMedGoogle Scholar
  16. 16.
    Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y et al (2013) GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 66:719–725CrossRefPubMedGoogle Scholar
  17. 17.
    Krag M, Perner A, Wetterslev J, Wise MP, Borthwick M, Bendel S et al (2016) Stress ulcer prophylaxis with a proton pump inhibitor versus placebo in critically ill patients (SUP-ICU trial): study protocol for a randomised controlled trial. Trials 17:205CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Alhazzani W, Guyatt G, Marshall JC, Hall R, Muscedere J, Lauzier F et al (2016) Re-evaluating the Inhibition of Stress Erosions (REVISE): a protocol for pilot randomized controlled trial. Ann Saudi Med 36:427–433CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  • Søren Marker
    • 1
  • Mette Krag
    • 1
  • Morten Hylander Møller
    • 1
    Email author
  1. 1.Department of Intensive Care, 4131, Copenhagen University HospitalRigshospitaletCopenhagenDenmark

Personalised recommendations