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Title: A multicentre feasibility study evaluating stress ulcer prophylaxis using hospital-based registry data.
Austin Authors: Litton, Edward;Eastwood, Glenn M ;Bellomo, Rinaldo ;Beasley, Richard W;Bailey, Michael J;Forbes, Andrew B;Gattas, David J;Pilcher, David V;Webb, Steven A R;McGuinness, Shay P;Saxena, Manoj K;McArthur, Colin J;Young, Paul J
Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia
Intensive Care Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
Critical Care and Trauma Division, The George Institute for Global Health, Sydney, NSW, Australia
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Medical Research Institute of New Zealand, Wellington, New Zealand.
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
Issue Date: 1-Sep-2014
Publication information: Critical Care and Resuscitation; 16(3): 158-63
Abstract: It is unclear whether histamine-2 receptor blockers (H2RBs) or proton pump inhibitors (PPIs) are preferred for stress ulcer prophylaxis (SUP) in intensive care unit patients. Suitably powered comparative effectiveness trials are warranted.To establish the feasibility of collecting process-of-care and outcome data relevant to a proposed interventional trial of SUP using existing databases.A retrospective cohort study conducted in seven Australia and New Zealand tertiary ICUs, including all patients ≥18 years admitted between 1 January 2011 and 31 December 2012.Doses of dispensed PPIs and H2RBs, upper gastrointestinal bleeding events, upper respiratory tract colonisation with pathogenic bacteria, Clostridium difficile infections and inhospital mortality.All sites were able to contribute to the study and investigators reported that data were generally easy to obtain. A median dose/ICU of 477 g of PPIs (interquartile range [IQR], 430.5-865 g), and 408.5 g (IQR, 109-1630.2 g) of H2RBs, were dispensed over the 2 years of the study. The median proportion of patients/ICU with upper GI bleeding complicating admission was 1.4% (IQR, 0.3%-1.8%). Colonisation of the respiratory tract with gram-negative bacteria occurred in a median of 7.1% of patients/ICU (IQR, 6.3%-14.1%). Pseudomembranous colitis occurred in hospital in a median of 1.4% of patients (IQR, 0.9%-2%) and inhospital mortality was 10.6% (95% CI, 9.5%- 11.7%).It is feasible to use existing data sources to measure process-of-care and outcome data necessary for a registry-based interventional trial of SUP.
Gov't Doc #: 25161016
Journal: Critical Care and Resuscitation
Type: Journal Article
Subjects: Clostridium difficile
Cohort Studies
Enterocolitis, Pseudomembranous.etiology
Feasibility Studies
Histamine H2 Antagonists.therapeutic use
Hospital Records
Peptic Ulcer.prevention & control
Pneumonia, Ventilator-Associated.etiology
Proton Pump Inhibitors.therapeutic use
Retrospective Studies
Treatment Outcome
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