Display options
Cite
Ogasawara O, Kojima T, Miyazu M, et al. Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study. J Intensive Care. 2020;8:10doi: 10.1186/s40560-020-0427-8.
Ogasawara, O., Kojima, T., Miyazu, M., & Sobue, K. (2020). Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study. Journal of intensive care, 810. https://doi.org/10.1186/s40560-020-0427-8
Ogasawara, Osamu, et al. "Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study." Journal of intensive care vol. 8 (2020): 10. doi: https://doi.org/10.1186/s40560-020-0427-8
Ogasawara O, Kojima T, Miyazu M, Sobue K. Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study. J Intensive Care. 2020 Jan 16;8:10. doi: 10.1186/s40560-020-0427-8. eCollection 2020. PMID: 31988751; PMCID: PMC6966877.
Copy Download .nbib Format: NLM
Share it on

J Intensive Care. 2020 Jan 16;8:10. doi: 10.1186/s40560-020-0427-8. eCollection 2020.

Impact of the stress ulcer prophylactic protocol on reducing the unnecessary administration of stress ulcer medications and gastrointestinal bleeding: a single-center, retrospective pre-post study.

Journal of intensive care

Osamu Ogasawara, Taiki Kojima, Mitsunori Miyazu, Kazuya Sobue

Affiliations

  1. 1Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Science, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan.
  2. Department of Anesthesiology, Aichi Children's Health and Medical Center, 7-426, Morioka-cho, Obu, Aichi 474-0031 Japan.

PMID: 31988751 PMCID: PMC6966877 DOI: 10.1186/s40560-020-0427-8

Abstract

BACKGROUND: Clinically significant gastrointestinal bleeding from stress ulcers increases patient mortality in intensive care, and histamine type 2 receptor blockers and proton pump inhibitors as stress ulcer prophylaxes were reported to decrease the incidence of that.Although medical checklists are widely used to maintain high compliance with medications and interventions to improve patient outcome in the intensive care field, the efficacy of medical checklists regarding the incidence of gastrointestinal bleeding and the reduction of unnecessary administration of stress ulcer prophylaxis medications has not been sufficiently explored to date.This study aimed to investigate the incidence of gastrointestinal bleeding and the rate of administering stress ulcer prophylaxis medication before and after setting administration criteria for stress ulcer prophylaxis and introducing a medical checklist for critically ill adults.

METHODS: This was a retrospective pre-post study at a single-center, tertiary adult and pediatric mixed ICU. Adult patients (≥ 18 years) who were admitted to the ICU for reasons other than gastrectomy, esophagectomy, pancreatoduodenectomy, and gastrointestinal bleeding were analyzed. A medical checklist and stress ulcer prophylaxis criteria were introduced on December 22, 2014, and the patients were classified into the preintervention group (from September to December 21, 2014) and the postintervention group (from December 22, 2014, to April 2015). The primary outcome was the incidence of upper gastrointestinal bleeding, and the secondary outcome was the proportion administered stress ulcer prophylaxis medications.

RESULTS: One hundred adult patients were analyzed. The incidence of upper gastrointestinal bleeding in the pre- and postintervention groups was both 4.0% [95% confidence interval, 0.5-13.7%]. The proportion administered stress ulcer prophylaxis medications decreased from 100 to 38% between the pre- and post-intervention groups.

CONCLUSIONS: After the checklist and the criteria were introduced, the administration of stress ulcer prophylaxis medications decreased without an increase in upper gastrointestinal bleeding in critically ill adults. Prospective studies are necessary to evaluate the causal relationship between the introduction of them and gastrointestinal adverse events in critically ill adults.

© The Author(s). 2020.

Keywords: Checklist; Critical care; Gastrointestinal hemorrhage; Hematemesis; Melena

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

References

  1. Intensive Care Med. 2014 Jan;40(1):11-22 - PubMed
  2. JAMA. 2016 Feb 23;315(8):801-10 - PubMed
  3. Crit Care Med. 1983 Jan;11(1):13-6 - PubMed
  4. Crit Care Med. 1985 Oct;13(10):818-29 - PubMed
  5. BMJ Qual Improv Rep. 2014 Apr 29;3(1):null - PubMed
  6. Crit Care. 2018 Jan 28;22(1):20 - PubMed
  7. Bone Marrow Transplant. 2013 Mar;48(3):452-8 - PubMed
  8. Am J Health Syst Pharm. 1999 Feb 15;56(4):347-79 - PubMed
  9. Am J Gastroenterol. 2012 Jul;107(7):1011-9 - PubMed
  10. Am J Gastroenterol. 2012 Jul;107(7):1001-10 - PubMed
  11. Infect Control Hosp Epidemiol. 2010 May;31(5):431-55 - PubMed
  12. Crit Care Med. 2009 Oct;37(10):2775-81 - PubMed
  13. J Trauma. 1974 Mar;14(3):187-96 - PubMed
  14. Chest. 2001 Apr;119(4):1222-41 - PubMed
  15. Am J Respir Crit Care Med. 2011 Sep 15;184(6):680-6 - PubMed
  16. N Engl J Med. 1994 Feb 10;330(6):377-81 - PubMed
  17. Ann Intern Med. 1987 Apr;106(4):562-7 - PubMed
  18. Intensive Care Med. 1999 Jul;25(7):686-96 - PubMed
  19. JAMA. 2009 May 27;301(20):2120-8 - PubMed
  20. Crit Care Med. 2010 Nov;38(11):2222-8 - PubMed
  21. Intensive Care Med. 1998 Mar;24(3):217-23 - PubMed

Publication Types