Implementation of Stress Ulcer Prophylaxis (SUP) in an Intensive Care Unit (ICU)

Abstract

Background: Critically ill patients are at high risk for developing stress ulcer bleeding, which may increase the length of hospitalization and mortality rate. Stress ulcer prophylaxis could be done either with PPIs or with H2 receptor blockers, which were prescribed in critically ill patients. Aim: This cross-sectional study was accomplished in an intensive care unit to implement new stress ulcer prophylaxis.  Methods: This study was conducted in a tertiary hospital of Kermanshah province, west of Iran. Patients who were hospitalized for at least 72 hours and received SUP prophylaxis, were included in our study. Updated ASHP guideline was used for calculating SUP risk score. Patients received either PPIs or H2RA (intravenously or enteral). Efficacy and safety of early changes to enteral route were evaluated in one year and cost was calculated in three years’ period.  Results: This study was conducted on 150 patients with a mean age of 58 ± 18 years old. More than half of patients (53.3%) were male. Stress ulcer prophylaxis was prescribed for all critically ill patients, regardless of the risk of GI bleeding while only 76.6% of patients had an appropriate indication for receiving SUP protocol. Six patients in the PPIs group (4 in intravenous and 2 in enteral) experienced gastrointestinal bleeding. Changing the route of administration from intravenous to intravenous over a three-year period resulted in a decrease in the mean use of pentoprazole vials from 12 to 4 per patient. Conclusion: Early changing (within 72 hours) SUP from IV to enteral is safe and cost-saving approach.