Original Article

Evaluation of Stress Ulcer Prophylaxis Guideline in the Intensive Care Units of a Teaching Hospital: A Cross Sectional Study


Background: One of the complications of critical ill patients admitted to intensive care unit (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis (SUP) should be administered to all critically ill patients with at least one major risk factor and two or more minor criteria.
Methods: This study was performed during 6 months from October 2013 to December 2013 in Namazi Hospital intensive care units to assess the appropriate administration of SUP, according to American Society of Health-System Pharmacists (ASHP) protocol. Candidate for SUP according the ASHP guideline is considered if there is a at least one major risk factor or two or more minor risk factors.
Results: Ninety-four patients were enrolled (46 men and 48 women). The mean age of study subjects was 51.5 years. The most major risk factor to stress ulcer found to be mechanical ventilation more than 48 hours (53%). The most minor risk factor for stress ulcer was ICU admission for less than one week (23.5%). Most prescribed medication for stress ulcer prophylaxis was intravenous Pantoprazole (44.7%). Our results have shown that about 74% patients were candidate for SUP according the ASHP guideline. 13(13.8%) of patients had only major risk factors. 5 (5.3%) of patients received SUP while they did not have at least one major risk factor or two or more minor risk factors.
Conclusion: Our results have shown that 76.2% of the total SUP administrations were compliant with the ASHP guideline. Among the prescribed medication for SUP, intravenous pantoprazole had the highest percentage of administration (44.7%) and oral omeprazole had the lowest percentage of administration (7.4%). According to the results of our study, 72% of the route administrations are compliant with the ASHP guideline.

1. Cook DJ, Griffith LE, Walter SD, et al. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001; 5:368-375.
2. Plummer MP, Blaser AR, Deane AM. Stress ulceration: prevalence, pathology and association with adverse outcomes. Crit Care 2014; 18:213.
3. Weinhouse G. Stress ulcers in the intensive care unit: Diagnosis, management, and prevention. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on January 04, 2018.)
4. Cook D, Guyatt G. Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients. N Engl J Med 2018;378(26):2506-2516.
5. Avendaño-Reyes JM, Jaramillo-Ramírez H. Prophylaxis for stress ulcer bleeding in the intensive care unit . Rev Gastroenterol Mex 2014;79(1):50-5.
6. Mohebbi L, Hesch K. Stress ulcer prophylaxis in the intensive care unit. Proc (Bayl Univ Med Cent) 2009; 22(4):373-6.
7. ASHP Therapeutic guidelines on stress ulcer prophylaxis. ASHP commission on therapeutics and approved by the ASHP board of directors on November 14, 1998. Am J Health Syst Pharm 1999; 56:347–79.
8. Barletta JF, Bruno JJ, Buckley MS, Cook DJ. Stress Ulcer Prophylaxis. Crit Care Med 2016;44(7):1395-405
9. Krag M, Perner A, Wetterslev J, et al. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Med 2015; 41:833-45.
10. Frandah W, Colmer-Hamood J, Nugent K, et al. Patterns of use of prophylaxis for stress-related mucosal disease in patients admitted to the intensive care unit. J Intensive Care Med 2013; 29:96-103.
11. Holloway K, Green T. Drug and therapeutics committees: a practical guide: World Health Organization; 2003. Available at: http://apps.who.int/medicinedocs/en/d/Js4882e/. Accessed 27 March 2017.
12. Maiti R, Bhatia V, Padhy BM, Hota D. Essential Medicines: An Indian Perspective. Indian J Community Med 2015; 40:223-32.
13. Foroughinia F, Madhooshi M. Attachment to stress ulcer prophylaxis guideline in the neurology wards of two teaching and non-teaching hospitals: A retrospective survey in Iran. J Res Pharm Pract 2016; 5(2): 138-141.
14. Horsa BA, Ayele Y, Ayalew MB. Assessment of pharmacologic prophylaxis use against stress ulcer in the medical wards of University of Gondar Hospital. SAGE Open Med 2019;7:2050312119827409.
15. Farrell CP, Mercogliano G, Kuntz CL. Overuse of stress ulcer prophylaxis in the critical care setting and beyond. J Crit Care 2010;25(2
IssueVol 8, No 2 (Spring 2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v8i2.3830
Stress Ulcer Prophylaxis Critically Ill Patients Cross Sectional Study

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Vazin A, Mousavinasab SR, Sabetian G. Evaluation of Stress Ulcer Prophylaxis Guideline in the Intensive Care Units of a Teaching Hospital: A Cross Sectional Study. J Pharm Care. 8(2):65-69.