Stress ulcer prophylaxis in critically ill children: A multicentre observational study of practice patterns
CCCF ePoster library. Duffett M. Oct 4, 2017; 198100; 99
Mark Duffett
Mark Duffett
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Rate & Comment (0)

Stress ulcer prophylaxis in critically ill children: A multicentre observational study of practice patterns

Duffett, Mark1,2; Chan, Alice3; Closs, Jordan2; Jin, Yanling1; McGloin, Rumi4; McKelvie, Greg5: Pong, Sandra6; Seto, Winnie6; Slaney, Heather7; Vaninetti, Gina8. 

1McMaster University, Hamilton, Canada; 2McMaster Children’s Hospital, Hamilton, Canada; 3Stollery Children's Hospital, Edmonton, Canada; 4BC Children's Hospital, Vancouver, Canada; 5Vancouver Island Health Authority, Victoria, Canada; 6Hospital for Sick Children, Toronto, Canada; 7Janeway Child Health Centre, St. John's,, Canada; 8IWK Health Centre, Halifax, Canada.

Introduction: Despite limited data on the effectiveness of prophylaxis, medications to prevent stress ulcer-related gastrointestinal bleeding are commonly used in critically ill children.
Objectives: Our objective was to describe current stress ulcer prophylaxis practice patterns in Canadian Pediatric Intensive Care Units (PICUs).
Methods: In this multi-centre audit of practice patterns, the pharmacist(s) working in each participating PICU collected data on all patients who were ventilated during an 8 week period. The data collected focused on stress ulcer prophylaxis, other PICU interventions, concomitant medications and adverse effects (gastrointestinal bleeding, C difficile-associated diarrhea, and new respiratory infections). We defined stress ulcer prophylaxis as the use of a proton-pump inhibitor (PPI), histamine-2 receptor antagonist (H2RA) or sucralfate within the first 2 PICU days among children who had not been on these medication and home and had no evidence of bleeding.
Results: 7 of the 16 PICUs in Canada participated. We included 378 children who were ventilated for a median (IQR) of 4 (2, 8) days and stayed in the PICU for a median (IQR) of 4 (2, 10) days. The median (IQR) age was 1.2 years (3 months, 7 years). PICU mortality was 5%. Many children received acid suppression for indications other than stress ulcer prophylaxis; 70% (95% CI 65 to 75%) of all children received some acid suppression during their PICU stay. 53% (95% CI 48 to 59%) of eligible children received stress ulcer prophylaxis for a median (IQR) or 6 (3 to 12) days. The percentage of children receiving stress ulcer prophylaxis in each centre varied from 0 to 100%. H2RAs were the most commonly used (63%), followed by PPIs (25%) and sucralfate (5%). 7% received more than 1 drug. When compared to eligible children who did not receive prophylaxis, those who received stress ulcer prophylaxis were older (median age 8 months vs. 16 months, p = 0.008), and stayed in the PICU longer (median 5 days vs. 3 days, p = 0.02), but their duration of ventilation was not different (median 4 days vs. 3 days, p =0.07). PICU mortality was also not different (4.9% vs. 4.2%, p = 0.99). Stress ulcer prophylaxis was continued on the PICU transfer orders for 27% (95% CI 23 to 32%) of these children. Gastrointestinal bleeding was reported in  21 (5.6%) children, only 3 (0.8%) were clinically important. 18% of children were treated for a new respiratory tract infection in the PICU. No child developed CDAD.
Conclusions: Stress ulcer prophylaxis is common, but there is important variability in practice. Clinically important gastrointestinal bleeding and C difficile-associated diarrhea is rare in this population and the utility of routine stress ulcer prophylaxis should be examined.

    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Save Settings