PURPOSE: Approximately 75%-100% of critically ill patients have some endoscopic evidence of gastroduodenal or upper gastrointestinal lesions that can occur within 24 hours after ICU admission. Current standard practices of stress ulcer prophylaxis (SUP) in the ICU using proton pump inhibitors (PPIs) has resulted in its widespread overuse. Despite limited data showing benefit, SUP in the ICU continues to be given in most ICU settings, even when patients are enterally fed. The purpose of our study was to determine if SUP in the critical care setting lessens the incidence of stress-related mucosal bleeding (SRMB) in patients who are receiving enteral feeding.
METHODS: A prospective, randomized study was conducted on 80 patients admitted to the ICU who were receiving enteral feeding and free of known GI bleeding. Patients were randomized into one of two groups: control group who received standard of care SUP daily; and experimental group who did not receive any SUP. We then recorded the occurrence of SRMB as defined as overt bleeding in association with hemodynamic compromise and confirmed with endoscopic evaluation.
RESULTS: Fisher’s Exact Test shows no significant difference in the frequency of mucosal bleeding, as suggested by a drop of more than 2 gm/dL of hemoglobin along with overt bleeding, between patients who were given SUP and those who did not receive prophylaxis (p=0.707; RR=0.6 [95% CI: 0.16-2.29]). Furthermore, we did not observe any increase in incidence in major side effects or morbidity from PPI use in patients who received PPIs as compared to those who did not.
CONCLUSIONS: Our analysis suggests that withholding PPI prophylaxis in critically ill patients receiving enteral feeding does not result in an increase in incidence of stress-related mucosal bleeding as we were not able to detect any significant differences between groups.
CLINICAL IMPLICATIONS: Inappropriate use of PPIs increases drug interactions, adverse side effects and unnecessary hospital costs. Our study demonstrates the necessity for improvement measures to reduce overuse of SUP in critically ill patients who are receiving enteral feeding.
DISCLOSURE: The following authors have nothing to disclose: Jennifer Kam, Justin Pi, Sami Abdul-Jawad, Chintan Modi, Deepali Dixit, Robert Spira, Marc Adelman
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