GI prophylaxis

[ontime]

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ok here is another one.

Everyone that is admitted into our service is getting previcid. The Residents answer was it prevents any GI complication. I looked for articles about this and what i found was mostly GI prophylaxis in the ICU with Vent patients only. most article said that in no risk or slight risk dont even worry about it. The Risk factors include:
mechanical ventilation
coagulopathy
brain0spinal cord injury
burns >35%
hypoperfusion
NSAID's
Corticosteroid use
Hx of GI hemorrhage, PUD or gastritis

But they give to everyone admitted. What are your thoughts on this

by the way im the worst speller in the world

 

[AJM]

You are correct, ontime. The main inpatient population that should get universal GI prophylaxis are the ICU patients (both on and off mechanical ventilation). Even if they are not intubated, most of the time they are on pressors, steroids, or have one of the other risk factors for ulcers, so it is standard practice to give GI prophylaxis to the entire ICU population.

Outside of the ICU, such as in the medicine wards, it is not indicated to universally give GI prophylaxis, unless the patient has a risk factor.

 

[TommyGunn04]

I remember most of the gen med patients at my school getting GI prophylaxis as well, often with a PPI rather than an H2 blocker. I've been told by residents that this is to avoid "stress ulcers," and have been given the impression that there is a reputable body of literature suggesting that even the stress of being an inpatient, being NPO, etc. makes one significantly more susceptible to developing an ulcer, regardless of one's history. They make it out to be a cost-effective, evidence-based thing. So now I'm curious! Has anyone found any evidence???

 

[ontime]

ive looked for articles there are few that deal with this. most seem to be Meta-analysis. Cook D et al. seems to have done a bit of research in this, but in the past. i am looking for info on this as we speak, or type lol. i belive in criticle care this is a good idea, but on every general medicine patient it doesnt seem cost effective. im only MSIII so my experience is lacking. but trying to gain it as i go

 

[debvz]

Not able to comment on literature to support it...

...but everyone on our medicine service gets Protonix 40mg for GI prophylaxis.

 

[kinetic]

Moreover, if you read Marino's 'ICU Book', he states that the best prophylaxis for ICU patients to prevent stress ulcers is really sucralfate. It is comparable in efficacy and much cheaper for the institution. However, if you suggest this, you'll probably get dragged out back and beaten. (P.S. This is when I decided that Marino was a waste of time to read.)

 

[Annette]

We (the royal we?) didn't give everyone in the MICU stress prophylaxis- usually those intubated, GI bleeds and hx of GIbleeds/gerd or on home PPI/H2. Tried to DC as quickly as possible when we could b/c of side effects-arrythmias,etc. Also, ran out of protonix and or filters a couple of times!

 

[Hotsauce21]

lol. ive heard some people say that it also prevents w/u for MI--you wont get that nonspecific "chest pain" call.
However, this is unsubstantiated--it could be right, i dont know--im only aware of ICU indications tho. Someone should do a study.

also--arrhythmias?? ive never heard of that--at least for ppi's.

Moreover, if you read Marino's 'ICU Book', he states that the best prophylaxis for ICU patients to prevent stress ulcers is really sucralfate. It is comparable in efficacy and much cheaper for the institution. However, if you suggest this, you'll probably get dragged out back and beaten. (P.S. This is when I decided that Marino was a waste of time to read.)