Rebecca Wytiaz, PGY1

Nationwide Children's Hospital, Groveport, Ohio

Objectives: 

Objective 1: Discuss the relevance of stress ulcers and pediatric-specific risk factors for developing stress ulcers.
Objective 2: Evaluate the frequency of proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) prescribing and associated implications in pediatric intensive care unit (PICU) patients.
Objective 3: Identify future areas of research pertaining to stress ulcer prophylaxis (SUP) use in the PICU.

Abstract:

Children in critical care settings experience high-stress situations, which may lead to gastrointestinal bleeds. The pathophysiology of upper gastrointestinal bleeds suggests that acid-suppressing agents, such as proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA), prevent the incidence of bleeds by restoring the normal acidity and integrity of the upper gastrointestinal tract. The significant perceived benefit of H2RAs and PPIs leads to almost universal use of these agents as prophylaxis for patients admitted to the pediatric intensive care unit (PICU). Pediatric guidelines describing the initiation of PPI and H2RA for stress ulcer prophylaxis (SUP) in critically ill patients are lacking. This deficiency leads to variable prescribing practices and may lead to inappropriate initiation of and duration of use of PPIs and H2RAs. This study was a retrospective chart review at a large free-standing pediatric hospital. The review identified patients who were over the age of 28 days and under the age of 18 years with a PICU admission from August 1, 2016 to July 31, 2018 and who received either PPI or H2RA or met major criteria for stress ulcers without prophylaxis. Patients were excluded if they did not meet the age criteria described, had a history of transplantation, were admitted for trauma, or had acid-suppressive therapy initiated before hospital or PICU admission. The primary objective of this project was to describe the rate of PPI and H2RA prescribing as SUP for patients admitted to the PICU. Secondary objectives included the number of PICU patients with indications for SUP without therapy during admission, indications associated with SUP initiation, doses utilized or prescribed, total days of therapy, number of patients with continuation of therapy upon transfer from PICU, rate of new prescriptions for PPIs and H2RAs upon hospital discharge, and medication costs associated with inappropriate SUP use in the PICU. Appropriate indications for SUP were determined using literature-based major and minor criteria for stress ulcers to best capture the magnitude of prescribing. Data collected was analyzed to identify prescribing practices and the rate of inappropriate SUP therapy in the PICU. Results will be submitted within final slides. Conclusion will be submitted within final slides.

Handout Slides:

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