Intravenous proton pump inhibitor uses for stress ulcer prophylaxis in the critically ill: a single-center study in Pakistan

Abstract

Introduction: Irrational use of intravenous (IV) proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) in critically ill patients increases the risk of adverse drug reactions (ADRs), and may lead to longer stays in the intensive care unit (ICU).

Methodology: A single-center, retrospective, observational study was conducted to assess the practices with prescribing IV SUP in critically ill adult patients treated at ICUs between January 2020–December 2022. Data was collected from electronic medical records, using a pre-designed checklist. Appropriateness of SUP administration was determined using the American Society of Health-System Pharmacists (ASHP) recommendations.

Results: Medical records of 1076 patients were analyzed; majority of patients (80.9%; n = 873) received IV SUP during their ICU stay, with the most commonly prescribed drug being omeprazole (99.2%). 75.5% of patients had no major or minor risk factors based on ASHP guidelines. The rationale of SUP was deemed appropriate in 51.7% of cases. Among patients treated at specific ICU wards, male patients were less likely (OR: 0.587 [95% CI: 0.345–0.998]; p = 0.048), while ventilated patients were more likely (OR: 2.525 [95% CI: 1.219–5.233]; p = 0.013) to receive SUP. Furthermore, ≥10 days of hospital stay corresponded to notable increase (OR: 4.076 [95% CI: 0.870–19.098]; p = 0.086) in the probability of receiving SUP.

Conclusions: The results may provide a basis for developing protocols related to acid-suppressive therapy in critically ill adults, calling for heightened awareness and tailored interventions to optimize pharmacological care in ICU settings.