Survey of Medications for the Inhibition of Stress Erosions (SURMISE): A Canadian Survey
CCCF ePoster library. Shears M. 10/26/15; 117301; P41
Melissa Shears
Melissa Shears
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Topic: Survey (quantitative or qualitative)

Survey of Medications for the Inhibition of Stress Erosions (SURMISE): A Canadian Survey

Melissa Shears, W. Alhazzani, J. Marshall, J. Muscedere, R. Hall, G. Guyatt, S. English, P. Dodek, F. Lauzier, S. Kanji, M. Duffett, J. Barletta, M. Alshahrani, Y. Arabi

Department of Medicine, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada | Department of Medicine, Division of Critical Care. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada | Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada | Department of Medicine, Queen's University, Kingston, Canada | Department of Critical Care, Dalhousie University, Halifax, Canada | Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada | Department of Medicine, University of Ottawa, Ottawa, Canada | Critical Care Medicine, University of British Columbia, Vancouver, Canada | Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, Canada | Department of Medicine, University of Ottawa, Ottawa, Canada | Department of Pediatrics, McMaster University, Hamilton, Canada | Pharmacy, Midwestern University, Glendale, United States of America | Emergency Medicine, University of Dammam, Dammam, Saudi Arabia | Intensive Care Department, King Saud

Introduction: Stress ulcer prophylaxis (SUP) to prevent upper gastrointestinal bleeding (GIB) has been a standard of care in the ICU for more than 4 decades, mainly with histamine-2-receptor antagonists (H2RAs). Proton pump inhibitors (PPIs) are increasingly prescribed, despite decreased GIB rates overall and growing concerns about associated infectious complications. Current Canadian intensivists’ perspectives have not been documented.

Objectives: Our objective was to understand the beliefs and prescribing habits regarding SUP in the ICU, and to gauge interest in participating in a randomized clinical trial (RCT) to inform future practice. We hypothesized that SUP is widely used, no longer restricted to H2RAs, and that clinicians perceive the need to revisit contemporary SUP in a RCT.


We created a short, self-administered survey instrument that focused on respondent and ICU characteristics, current stated SUP practice, beliefs about risk, and interest in a future trial. We pilot-tested the instrument, evaluated its clinical sensibility, and following ethics approval, administered the survey by email to intensivist members of the Canadian Critical Care Trials Group (CCCTG). We sent a reminder via email 3 and 5 weeks later.


We received 95 of 112 (85%) of surveys from the validated respondent pool from May to June 2015. Intensivists were in practice for mean (SD) of 14.5 (± 8.8) years. SUP use was most often reported in patients who were: 1) invasively mechanically ventilated, 2) expected to be ventilated for 2 days or more, and 3) mechanical ventilated but nil per os (NPO). Respondents reported discontinuing SUP when patients were no longer mechanically ventilated (75%), no longer NPO (22%), or discharged from ICU (19%). Analyzing results by center rather than respondent group, SUP agents reportedly used were PPIs (20%) or H2RAs (32%) while both drug classes were used in some centers (48%). SUP was most commonly prescribed as part of a standardized order set (80% of centers). 85% of CCCTG intensivists responding endorsed the need for a large rigorous RCT of PPI versus placebo to inform practice.


In this self-administered survey of Canadian intensivists, SUP is reportedly used primarily for the duration of mechanical ventilation; 68% of centers have now incorporated PPIs in modern practice. CCCTG physicians believe that a placebo-controlled RCT is needed to evaluate the effectiveness and safety of contemporary SUP with PPIs.


Barletta JF, Erstad BL, Fortune JB. Stress ulcer prophylaxis in trauma patients. Crit Care. 2002;6:526-30.

Cook DJ, Griffith LE, Walter SD, et al. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001;5:368-75.

Eastwood GM, Litton E, Bellomo R, Bailey MJ, Festa M, Beasley RW, Young PJ. Opinions and practice of stress ulcer prophylaxis in Australian and New Zealand intensive care units. Crit Care Resusc 2014;16(3):170-174.

MacLaren R, Reynolds PM, Allen RR. Histamine-2 Receptor Antagonists vs Proton Pump Inhibitors on gastrointestinal tract hemorrhage and infectious complications in the Intensive Care Unit. JAMA Intern Med 2014;174(4):564-574.

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