Krag M, Perner A, Wetterslev J, Wise M P, Borthwick M, Bendel S, McArthur C, Cook D, Nielsen N, Pelosi P, Keus F, Guttormsen A B, Moller A D, Møller M H
Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2015 May;59(5):576-85. doi: 10.1111/aas.12508.
Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries.
Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects. Fisher's exact test was used to assess differences between groups.
Ninety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP agent, used in 66% of ICUs (64/97), and H2-receptor antagonists were used 31% (30/97) of the units. Twenty-three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP.
In this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.
应激性溃疡预防（SUP）可能会降低重症监护病房（ICU）患者胃肠道出血的发生率，但感染风险可能会增加。在本研究中，我们旨在描述成人ICU中的SUP实践情况。我们假设，SUP的患者选择在不同国家内部和不同国家之间都存在差异。
邀请成人ICU参与该调查。我们记录了国家、医院类型、ICU的类型和规模、首选的SUP药物、是否存在当地指南、报告的SUP适应证、停止SUP的标准以及对不良反应的担忧。采用Fisher精确检验评估组间差异。
11个国家的97个成人ICU参与了研究（8个来自欧洲）。除1个ICU外，所有ICU均使用SUP，64%（62/97）报告有SUP使用指南。质子泵抑制剂是最常用的SUP药物，66%的ICU（64/97）使用，31%的单位（30/97）使用H2受体拮抗剂。报告了23种不同的SUP适应证，最常见的是机械通气。26%（25/97）的ICU对所有患者都开具了SUP。充足的肠内营养是停止SUP最常见的原因，但19%（18/97）的患者在ICU出院时仍继续使用SUP。大多数人对使用SUP导致的医院获得性肺炎和艰难梭菌感染表示担忧。
在这项国际调查中，大多数参与的ICU报告使用SUP，主要是质子泵抑制剂，但许多单位没有指南；适应证差异很大，并且对感染性并发症存在担忧。
