Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Introduction: Prophylactic measures to prevent acute upper gastrointestinal bleeding (UGIB) due to stress ulceration is an important consideration in the treatment of critically ill patients. Evidence-based disease management is used to construct a guideline to identify patients who are at low risk for stress ulcer prophylaxis (SUP). Methods: 176 consecutive intensive care unit (ICU) admissions over a five week period were examined. Of these 176, 105 ICU patients met the inclusion criteria(ICU length of stay >24 hours, no existing UGIB, and must follow SUP guideline). From current research, four risk factors (coagulopathy, head trauma, mechanical ventilation, and history of UGIB) were selected to identify those patients at high risk for SUP. Patients with at least one risk factor were considered high risk and placed on SUP, while those without a risk factor were considered low risk and did not require SUP (famotidine, sucralfate, lansoprazole, or gastric feedings). Patients were monitored throughout their stay in the ICU for overt bleeding (coffee ground emesis, grossly positive GI aspirate, guaiac positive stool or GI aspirate, or endoscopic documentation)and clinically significant UGIB (overt UGIB with two point decline in hemoglobin, hypotension, and/or tachycardia). Results: Sixty patients were identified as high risk and placed on SUP. Six of the sixty high risk patients had overt bleeding. Forty-five patients were identified as low risk and did not require SUP. There were no instances of overt bleeding in low risk patients. Conclusion: The identification of low risk critically ill patients using an evidence based guideline can provide safe patient care without SUP. The consequences of following a SUP guideline include the avoidance of adverse pharmaceutical effects and cost savings.
