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
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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.

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