Pattern of intravenous proton pump inhibitors use in ICU and Non-ICU setting: a prospective observational study.
Pattern of intravenous proton pump inhibitors use in ICU and Non-ICU setting: a prospective observational study.
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DOI：
10.4103/1319-3767.70614
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发表时间：
2010-10-01
期刊：
影响因子：
--
通讯作者：
Alshaikh, Mashael K
中科院分区：
文献类型：
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作者：
Alsultan, Mohammed S;Mayet, Ahmed Y;Alshaikh, Mashael K
背景/目的：在具有特定危险因素的危重患者中，静脉抑酸治疗用于应激性溃疡预防已有十多年的历史。然而，缺乏关于将这种治疗扩展到非重症患者（非icu）的支持数据。本研究的目的是比较成人非ICU和ICU患者的适当适应症与当前的实践模式，不适当使用的影响因素和经济影响。材料和方法：在沙特阿拉伯利雅得的一家三级教学医院进行了一项前瞻性横断面研究。在连续4个月的时间里，所有接受静脉PPI治疗的住院患者年龄均在18岁及以上。根据现有文献和指南的资料，预先定义了适合使用静脉注射PPI的适应症的简明清单。结果：共有255例患者接受静脉注射PPI治疗。非ICU患者静脉PPI使用不当率（71.7%）明显高于ICU患者（19.8%）（P=0.01）。在非icu患者中不适当使用的最常见原因是应激性溃疡预防（SUP）。在ICU患者中，适合静脉PPI的指标是SUP（47.9%）、PUD（11.5%）和UGIB（20.8%）。在内窥镜手术中适当使用静脉PPI与在非icu患者中适当使用静脉PPI与随后使用口服PPI出院之间存在高度关联。在研究期间，静脉注射PPI不当使用的总直接成本（药物获取成本）估计为11000美元。结论：非icu患者静脉注射PPI使用不当，主要用于应激性溃疡预防，造成资源浪费。通过适当的政策、程序和循证指南，受过教育的内科医生和外科医生可以明确限制不适当的静脉注射PPI使用。
BACKGROUND/AIM: The use of intravenous acid-suppressive therapy for stress ulcer prophylaxis in critically ill patients with specific risk factors has been recommended for over a decade. However, there is a lack of supporting data regarding the extension of such therapy to non-critically ill patients (non-ICU). The aim of this study was to compare appropriate indications with current practicing patterns in adult non-ICU and ICU patients, contributing factors and financial impact of inappropriate use.MATERIALS AND METHODS: A prospective cross-sectional study was carried out at a tertiary teaching Hospital in Riyadh, Saudi Arabia. For a period of 4 consecutive months, all hospitalized patients on IV PPI, aged 18 and above, were identified. A concise listing of indications considered appropriate for the use of IV PPI was pre-defined based on material from available literature and guidelines.RESULTS: A total of 255 patients received IV PPI. Inappropriate use of IV PPI was significantly higher in non-ICU (71.7%) than in ICU (19.8%) patients (P=0.01). The most common cause for inappropriate use in non-ICU patients was stress ulcer prophylaxis (SUP). In ICU patients, appropriate indicators for IV PPI were SUP (47.9%), PUD (11.5%), and the UGIB (20.8%). There was a high association between appropriate uses of IV PPI with respect to endoscopic procedure and also between appropriate uses of IV PPI to subsequent discharge with oral PPI in non-ICU patients. The total estimated direct cost (drug acquisition cost) for inappropriate use of IV PPI during the study period was 11,000 US dollars.CONCLUSION: Inappropriate IV PPI utilization was predominant in non-ICU patients, mostly for stress ulcer prophylaxis that leads to a waste of resources. Applying appropriate policies, procedures and evidence-based guidelines, educated physicians and surgeons can clearly limit inappropriate IV PPI use.