Assessing the Appropriateness of Stress Ulcer Prophylaxis in Critically Ill ICU Patients at CAMC

Introduction: Stress ulcer prophylaxis (SUP) with proton pump inhibitors (PPIs) or H2 blockers are administered in critically ill patients patients to prevent stress-related mucosal bleeding from the upper gastrointestinal tract. The reported prevalence of GI bleeding in an intensive care unit (ICU) setting is estimated to be 2.6%. Our study aims to assess the appropriate adherence of SUP guidelines in the ICUs at CAMC and assess for appropriate discontinuation of ulcer preventing medications upon transfer of the patient to the floor. Methods: This is a retrospective chart review of patients who were admitted to all the ICUs over last 10 years. Patients on PPIs at admission or had an admitting diagnosis of GI bleed were excluded. SUP criteria included either having coagulopathy and/or mechanical ventilation for greater than 48 hours and/or two or the following minor criteria: 1) sepsis, 2) ICU stay for more than a week, 3) GI bleed for six or more days and/or 4) glucocorticoid therapy (more than 250mg hydrocortisone or equivalent). Results: The charts of 203 randomly selected medical ICU (MICU), cardiopulmonary ICU (CPICU), surgical ICU (SICU) patients were retrospectively reviewed. Of those 203, 69 (34.0%) patients were on PPIs or H2 blockers at admission and therefore were excluded. Of the 134 (66.0%) remaining patients not on PPIs or H2 blockers the mean age was 53.2 years (±17.4) and the average time spent in the ICU was 5.2 days (±7.5). The majority were males 74 (56.9%). Of those patients not on PPIs or H2 blockers, only 55 (41.0%) met the full criteria for SUP. Of those 55 patients, 39 (70.9%) were given PPIs, 4 (7.3%) were given H2R antagonists and 12 (21.8%) were not receiving any prophylaxis during their ICU stay. Of those 43 patients on SUP, 11 (25.6%) discontinued the SUP upon discharge from ICU, whereas 16 (37.2%) remained on SUP and 16 (37.2%) were unknown as to whether it was stopped. Conclusion: In conclusion, there were significant percentage of patients who met the clinical criteria but were not administered SUP. In majority of patients, SUP was not discontinued upon transfer of patient to the floor thus leading to inappropriate use of ulcer preventing medications and side-effects. Therefore, our institution is not strictly adherent to SUP guidelines. Educating the physicians about SUP guidelines and side-effects of the ulcer preventing medications is warranted.