• Diagnosis
• Gastroesophageal reflux disease
• Management
• Pathophysiological mechanisms
• Risk factors

• Humans
• Gastroesophageal Reflux/diagnosis
• Gastroesophageal Reflux/therapy
• Gastroesophageal Reflux/epidemiology
• Gastroesophageal Reflux/physiopathology
• Global Health/statistics & numerical data
• Prevalence
• Risk Factors
• Treatment Failure

• Humans
• Anticoagulants/therapeutic use
• Anticoagulants/adverse effects
• Fibrinolytic Agents/therapeutic use
• Fibrinolytic Agents/adverse effects
• Gastrointestinal Hemorrhage/prevention & control
• Gastrointestinal Hemorrhage/chemically induced
• Histamine H2 Antagonists/therapeutic use
• Platelet Aggregation Inhibitors/therapeutic use
• Platelet Aggregation Inhibitors/adverse effects
• Proton Pump Inhibitors/therapeutic use

• American Society of Health-System Pharmacists
• Ethiopia
• stress ulcer
• stress ulcer prophylaxis
• surgical patients

• Humans
• Proton Pump Inhibitors/adverse effects
• Histamine
• Histamine H2 Antagonists/adverse effects
• Gastrointestinal Hemorrhage/chemically induced

• Adult gastroenterology
• Adult intensive & critical care
• Bleeding disorders & coagulopathies
• Clinical Trial
• Gastroduodenal disease

• Adolescent
• Adult
• Humans
• Gastrointestinal Hemorrhage/therapy
• Intensive Care Units
• Pantoprazole
• Pneumonia, Ventilator-Associated
• Proton Pump Inhibitors/therapeutic use
• Respiration, Artificial
• Randomized Controlled Trials as Topic

• CPMS ID 45782 Department of Health
• Hamilton Academy of Health Sciences Organization
• Canadian Institutes for Health Research
• The National Health and Medical Research Council of Australia

• aged
• chronic renal insufficiency
• fracture osteosynthesis
• gastrointestinal hemorrhage
• perioperative care

• GERD
• PPI
• Proton pump inhibitors
• acid-suppressive therapy
• misuse

• Humans
• Proton Pump Inhibitors/adverse effects
• Inappropriate Prescribing/prevention & control

• adverse outcomes
• histamine H2 receptor antagonists
• safety
• umbrella review

• Humans
• Infant, Newborn
• Histamine H2 Antagonists/adverse effects
• Pneumonia
• Enterocolitis, Necrotizing
• Proton Pump Inhibitors/adverse effects

• Diagnosis Procedure Combination
• Sepsis‐3
• administrative database
• claim database
• organ dysfunction

Background: The use of MV can easily lead to VAP especially in ICU patients. SUP, sedatives, statin and insulin have been proved to prevent VAP and improve the prognosis of patients. Our aim was to analyze the effects of SUP, sedative, statin, and insulin on patients with MV.

Methods: The occurrence of VAP and death in MV patients and VAP patients were explored by multivariate logistic regression and Cox regression to analyze analyses.

Results: Totally, 5277 cases who received MV in ICU from MIMIC IV database were included. There were 826 (15.7%) cases in VAP-group and 4451 (84.3%) cases in non-VAP group and there were 1914 (36.3%) cases in hospital mortalities altogether. No protective effect of drugs on VAP was found in MV patients. The risk of death was 1.43 times higher in MV patients taking midazolam than in propofol (aHR = 1.43 95% CI: 1.04,1.97). No protective effect of drugs on death was found in VAP patients.

Conclusion: Compared with midazolam, propofol is more recommended as sedation regimen in ICU patients with MV. Further high-quality studies are needed to confirm this finding.

• Guangzhou Municipal Science and Technology Bureau

• Adult
• Child
• Cross Infection/prevention & control
• Healthcare-Associated Pneumonia/epidemiology
• Healthcare-Associated Pneumonia/prevention & control
• Hospitals
• Humans
• Infant, Newborn
• Infection Control
• Pneumonia
• Pneumonia, Ventilator-Associated/prevention & control
• Ventilators, Mechanical/adverse effects

• CC999999 Intramural CDC HHS

• Trichosanthes extract
• antioxidant effective components group
• spectrum effect relationship
• validation

• Antioxidants/pharmacology
• Chromatography, High Pressure Liquid/methods
• Luteolin
• Plant Extracts/pharmacology
• Trichosanthes/chemistry

• Adult
• Aged
• Critical Illness/therapy
• Female
• Histamine
• Histamine H2 Antagonists/therapeutic use
• Humans
• Male
• Middle Aged
• Proton Pump Inhibitors/therapeutic use
• Ulcer

• intensive care unit
• pharmacist-led
• quality improvement
• stress ulcer prophylaxis
• systematic review

• enteral nutrition
• histamine 2 receptor antagonists
• nutrition
• proton pump inhibitor
• stress ulcer
• stress ulcer prophylaxis

Perioperative patients are at risk of developing stress ulcers (SU), which can cause clinically important bleeding. Stress ulcer prophylaxis (SUP) is widely applied to the patients in Intensive care unit (ICU) as well as the general ward, so it may lead to overmedication. However, there have been no surveys regarding SUP knowledge or prescribing habits.

Our study assessed the knowledge, attitudes, and prescribing behavior of the surgeons toward perioperative patients regarding SUP and determined factors associated with low knowledge and high level of prescribing behaviors.

We performed a cross-sectional survey using questionnaires, randomly sampling 1266 surgeons on their current SUP practices.

Proton pump inhibitors for SUP were used the most (94%); 43% used lansoprazole. Guideline awareness was inconsistent; the most familiar guideline was the National Medical Journal of China, and 46% were unaware of any guidelines. The predictors of low knowledge score regarding SUP in multivariable analysis were the hospital grade (p = 0.000), the type of hospital (p = 0.044), attendance at continuing education programs (p = 0.037), the awareness of clinical practice guidelines (CPGs) for SUP (p = 0.000). Twenty-one percent of physicians were high prescribers. High prescribing behavior was associated with hospital grade(p = 0.000), education level(p = 0.010) and attendance at continuing education programs (p = 0.000).

We found that most surgeons used SUP, primarily proton pump inhibitors. However, surgeons knew little about the SUP guidelines, which may lead to insufficient SUP knowledge and overmedication. In addition, hospital grade, the type of hospital and attendance at continuing education programs may also affect the low knowledge of SUP. Hospital grade, education level and attendance at continuing education programs may affect high prescribing behavior.

• Multi-center study
• Prescribing behavior
• Stress ulcer prophylaxis
• Surgeons

Elderly hip fracture patients are at risk of stress-related gastric mucosal damage, and upper gastrointestinal bleeding is one of the underrecognized but devastating complications.

Cite this article: EFORT Open Rev 2021;6:686-691. DOI: 10.1302/2058-5241.6.200053

• elderly
• fracture
• hip
• intestinal bleed
• prophylaxis
• proton pump inhibitors

Supplemental Digital Content is available in the text.

Histamine-2 receptor antagonists are commonly administered for stress ulcer prophylaxis in critically ill adults and may be associated with delirium development. We aimed to determine differential associations of histamine-2 receptor antagonist or proton-pump inhibitor administration with delirium development in patients admitted to a medical ICU.

Retrospective observational study using a deidentified database sourced from the University of North Carolina Health Care system. Participants were identified as having delirium utilizing an International Classification of Diseases-based algorithm. Associations among histamine-2 receptor antagonist, proton-pump inhibitor, or no medication administration and delirium were identified using relative risk. Multiple logistic regression was used to control for potential confounders including mechanical ventilation and age.

Academic tertiary care medical ICU in the United States.

Adults admitted to the University of North Carolina medical ICU from January 2015 to December 2019, excluding those on concurrent histamine-2 receptor antagonists and proton-pump inhibitors in the same encounter.

None.

We identified 6,645 critically ill patients, of whom 29% (n = 1,899) received mechanical ventilation, 45% (n = 3,022) were 65 or older, and 22% (n = 1,487) died during their medical ICU encounter. Of the 6,645 patients, 31% (n = 2,057) received an histamine-2 receptor antagonist and no proton-pump inhibitors, 40% (n = 2,648) received a proton-pump inhibitor and no histamine-2 receptor antagonists, and 46% (n = 3,076) had delirium. The histamine-2 receptor antagonist group had a greater association with delirium than the proton-pump inhibitor group compared with controls receiving neither medication, after controlling for mechanical ventilation and age (risk ratio, 1.36; 1.25–1.47; p < 0.001) and (risk ratio, 1.15; 1.07–1.24; p < 0.001, respectively).

Histamine-2 receptor antagonists are more strongly associated with increased delirium than proton-pump inhibitors. Prospective studies are necessary to further elucidate this association and to determine if replacement of histamine-2 receptor antagonists with proton-pump inhibitors in ICUs decreases the burden of delirium in critically ill patients.

• critical care
• delirium
• histamine H2 antagonists
• mechanically ventilated
• older adults
• proton-pump inhibitors

• cardiovascular
• critical care
• gastrointestinal hemorrhages
• histamine H2 antagonists
• proton pump inhibitors

• Medical Information Mart for Intensive Care III
• Stress ulcer prophylaxis
• gastrointestinal bleeding
• histamine-2 receptor blocker
• proton pump inhibitor
• sepsis

术中误吸是外科手术中常见的肺部并发症，麻醉和体位是导致术中误吸的主要因素。近年来，围手术期肺保护已受到外科和麻醉医师的广泛关注，如何加速术后康复进程，减少相关并发症发生，显著改善患者预后已成为当前外科治疗的主要目标。本文将以术中误吸为重点，从解剖、病理生理、表现、诊断、处理和预防等方面展开综述。

• Gastric acid
• Intraoperative aspiration
• Lung neoplasms
• Pepsin

The study aimed to investigate the preventive and therapeutic significance of octreotide combined with lansoprazole on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and its effects on serum amylase (AMS), inflammatory factors and immune function. A total of 132 patients who underwent ERCP in Shaoxing People's Hospital (Shaoxing, China) were enrolled in the study and allocated into two groups: The study group (octreotide plus lansoprazole, 68 cases) and the control group (octreotide alone, 64 cases). The incidence of PEP and post-ERCP hyperamylasemia (PEH), the concentrations of serum AMS, interleukin-17 (IL-17) and tumor necrosis factor-α (TNF-α), as well as the T-lymphocyte population in peripheral blood were detected. The AMS levels in the study group were significantly lower than those in the control group at 6 and 24 h after treatment (P<0.001). The incidence of PEP and PEH, symptom disappearance time and hospital stay in the study group were significantly lower than those in the control group after treatment (P<0.05). The levels of IL-17 and TNF-α in the study group were significantly lower than those in the control group after treatment (all P<0.05). The percentage of CD3⁺, CD4⁺, CD8⁺ cells and the ratio of CD4⁺/CD8⁺ in the study group were significantly higher than those in the control group after treatment (all P<0.05). The results indicated that octreotide combined with lansoprazole reduces AMS levels and the incidence of PEP, alleviates inflammation and improves the immune function.

• endoscopic retrograde cholangiopancreatography
• lansoprazole
• octreotide
• pancreatitis

Conduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST).

To identify studies, the following databases were systematically searched on October 14^th, 2018 and repeated on September 12^th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review.

Seventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I² = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I² = 36%).

This systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications.

• Antacids/adverse effects
• Antacids/therapeutic use
• Anti-Ulcer Agents/adverse effects
• Anti-Ulcer Agents/therapeutic use
• Humans
• Intensive Care Units
• Patient Discharge
• Pharmacies
• Pharmacists
• Proton Pump Inhibitors/adverse effects
• Proton Pump Inhibitors/therapeutic use

• Helicobacter pylori
• Non-steroidal anti-inflammatory drugs
• Peptic ulcer disease
• Proton pump inhibitor
• Risk-benefit

• Acute Kidney Injury/etiology
• Acute Kidney Injury/therapy
• Anemia/etiology
• Anemia/therapy
• Fever/etiology
• Fever/therapy
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/therapy
• Humans
• Postoperative Complications/therapy

• adult intensive & critical care
• intensive & critical care

• Clostridioides difficile
• Extracorporeal Membrane Oxygenation/adverse effects
• Histamine
• Humans
• Propensity Score
• Proton Pump Inhibitors/therapeutic use
• Retrospective Studies
• Ulcer

• the Ministry of Education, Culture, Sports, Science and Technology
• Ministry of Health, Labour and Welfare

Studies have shown the potential benefit of stress ulcer prophylaxis including histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in critically ill patients. However, the adverse effects of stress ulcer prophylaxis such as Clostridioides difficile infection (CDI) and hospital-acquired pneumonia have been reported. Abdominal septic shock is associated with increased risk of bleeding, CDI, and pneumonia; however, which ulcer prophylaxis might be associated with better outcomes in patients with septic shock after lower gastrointestinal tract perforation is unknown.

In this retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2015, we identified patients aged 18 years or older who received open abdominal surgery for lower gastrointestinal tract perforation and who used vasopressors and antibiotics within 2 days of admission. We performed propensity score matching and inverse probability of treatment weighting (IPTW) to compare the outcomes between patients who received H2RA and those who received PPI within 2 days of admission. The outcomes included gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia.

The propensity score matching created 1088 pairs of patients who received H2RA or PPI within 2 days of admission. There were no significant differences between the H2RA and PPI groups regarding gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission (0.74% vs 1.3%, risk ratio 0.57 (0.24–1.4), and P = 0.284), 28-day mortality (11.3% vs 12.9%, risk ratio 0.88 (0.68–1.1), and P = 0.386), CDI (0.64% vs 0.46%, risk ratio 1.4 (0.45–4.4), and P = 0.774), and hospital-acquired pneumonia (3.0% vs 4.3%, risk ratio 0.70 (0.45–1.1), and P = 0.138). IPTW analysis showed similar results.

There were no significant differences in gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia between H2RA and PPI in patients with septic shock after lower gastrointestinal tract perforation.

• Bleeding
• Clostridioides difficile infection
• Histamine-2 receptor antagonists
• Hospital-acquired pneumonia
• Mortality
• Peritonitis
• Proton pump inhibitors

• National Health Insurance Research Database
• asthma
• histamine 2 receptor antagonists
• population base study
• proton pump inhibitors

• Adult
• Cross-Over Studies
• Female
• Histamine H2 Antagonists/therapeutic use
• Hospital Mortality
• Humans
• Intensive Care Units
• Male
• Middle Aged
• Peptic Ulcer/prevention & control
• Proton Pump Inhibitors/therapeutic use
• Respiration, Artificial

• CIHR

This audit was aimed at studying current practices regarding the use of stress ulcer prophylaxis (SUP) in the Indian critical care setup, with the background aim of raising awareness regarding the use and indications of SUP in critically ill patients.

After registering the trial with the clinical trial registry, India, a structured audit questionnaire containing 26 questions pertaining to SUP was distributed through electronic media among clinicians working in the intensive care units (ICUs) across India. Responses obtained were statistically analyzed.

The questionnaire was sent to 550 clinicians. Only 197 responded, of whom 91.4% were anesthesiologists, 5.6% were physicians, and 3% were intensivists. The audit revealed that 33% respondents were unaware of the existing SUP guidelines and around 32% did not have protocols for SUP in their ICU. Sixty-nine percent of respondents felt that all ICU patients must receive SUP and 44.7% opined that it should be started on ICU arrival. Almost 94% knew that early enteral feeding is protective against stress ulceration. Only 24.9% responders agreed that there must be clear indications for SUP, and most of them were unaware of all the potential side effects. Once initiated, 43.7% respondents would stop prophylaxis when no indication was left, whereas 69 respondents would stop on ICU discharge.

There is a lack of awareness regarding initiation, choice of agent, adverse effects as well as termination of SUP in ICU and guidelines for the same. Institutional protocols should be in place and steps need to be taken to prevent unwarranted use.

Gupta D, Bhalotra AR, Singh R. Audit on Practices of Stress Ulcer Prophylaxis in Intensive Care Unit Patients. Indian J Crit Care Med 2020;24(3):160–167.

• Critical care
• H2 receptor locker
• Proton pump inhibitor
• Stress ulcer bleeding
• Sucralfate

• acid suppression
• multidisciplinary
• quality improvement
• stress ulcer prophylaxis

• acute care
• biomarker
• burns
• healing
• inflammation
• perioperative care

• bloodstream infection
• gastrointestinal bleeding
• inverse probability of treatment weighting (IPTW)
• propensity score
• sepsis

Stress ulcer is a severe complication in critically ill patients and causes a high mortality. The proton pump inhibitor esomeprazole is widely applied in the treatment of stress ulcers because of its powerful acid suppression ability. However, the mechanism of stress ulcer and the precise gastroprotective effect of esomeprazole in stress ulcer remain unclear.

In the present study, the rats with water-immersed and restraint (WIR)-induced stress ulcer were used to further elucidate the anti-ulcerogenic capacity of esomeprazole in stress ulcer in addition to its anti-acid secreting ability.

The rats were randomly divided into 5 groups: control group (NS), water-immersed and restraint group (WIR), high-dose application of esomeprazole plus stress ulcer-induced group (HE+WIR), low-dose application of esomeprazole plus stress ulcer-induced group (LE+WIR), and high-dose application of esomeprazole without stress ulcer-induced group (HE). Our study showed that the pretreatment of esomeprazole alleviated gastric tissue damage in both macroscopic and histopathological manifestations. Pretreatment of esomeprazole elevated the decline in PEG2 level affected by WIR; and it inhibited the secretion of gastric acid, gastrin and pepsin. Moreover, esomeprazole exerted its antioxidant effects by reducing malondialdehyde levels, enhancing the expressions of antioxidant factors like glutathione and superoxide dismutase (SOD) and reducing the compensatory transcriptional elevation of SOD1 gene. Esomeprazole also reduced the levels of MPO (myeloperoxidase), tumor necrosis factor (TNF)-α and interleukin (IL)-1β according to its anti-inflammatory effects. We further explored the possible mechanism of esomeprazole pretreatment on stress ulcer and demonstrated that esomeprazole attenuated the high phosphorylation levels of nuclear factor kappa B (NF-κB) p65 and p38 MAPK, and decreased the NF-κB p65 nuclear translocation induced by WIR related stress ulcer.

Our study provides some evidence that the esomeprazole pretreatment exerts gastroprotective effects in WIR-induced stress ulcer through not only its antisecretory effect but also its antioxidant effect by inactivating the p38 MAPK and NF-κB signaling pathways.

• MAPK-p38
• NF-κB
• esomeprazole
• oxidative stress
• stress ulcer

• acid suppressants
• all-cause mortality
• gastrointestinal bleeding
• histamine-2-receptor antagonists
• meta-analysis
• neonatal intensive care
• nosocomial pneumonia
• pediatric intensive care
• pediatric intensive care unit
• proton pump inhibitors
• stress ulcer prophylaxis
• systematic review

• Adolescent
• Anti-Ulcer Agents/therapeutic use
• Child
• Child, Preschool
• Clinical Protocols
• Critical Care
• Critical Illness
• Histamine H2 Antagonists/therapeutic use
• Humans
• Infant
• Infant, Newborn
• Proton Pump Inhibitors/therapeutic use
• Randomized Controlled Trials as Topic
• Stress, Psychological/prevention & control
• Stress, Psychological/psychology
• Ulcer/prevention & control
• Meta-Analysis as Topic
• Systematic Reviews as Topic

• Drug
• Heart Disease Prevention
• Stomach
• Thrombosis

Critically ill patients are at risk of developing stress ulcers in the upper digestive tract. Agents that suppress gastric acid are commonly prescribed to reduce the incidence of clinically important stress ulcer-related gastrointestinal bleeding. However, the indiscriminate use of stress ulcer prophylaxis in all patients admitted to the intensive care unit is not warranted and can have potential adverse clinical effects and cost implications. The present guidelines from the Sociedade Portuguesa de Cuidados Intensivos summarizes the current evidence and gives six clinical statements and an algorithm aiming to provide a standardized prescribing policy for the use of stress ulcer prophylaxis in the intensive care unit.

• Gastrointestinal bleeding
• non-variceal bleeding
• octreotide
• stress ulcer phrophylaxis