Inappropriate Stress Ulcer Prophylaxis in ICU
Trial question
What is the role of pharmacist-led intervention in ICU patients in reducing overuse stress ulcer prophylaxis?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 2199
2199 patients (788 female, 1411 male).
Inclusion criteria: adult patients receiving stress ulcer prophylaxis in the ICU.
Key exclusion criteria: prespecified indications for acid suppression therapy; GERD; peptic ulcer; MALT lymphoma; erosive esophagitis; gastroenteritis melanoma; eosinophilic esophagitis; Barrett's esophagitis; H. pylori infection.
Interventions
N=1181 pharmacist-led intervention (multifaceted intervention in addition to usual care given by pharmacists).
N=1018 usual care (ward rounds, monthly retrospective prescription reviews, and medication recommendations to physicians given by pharmacists).
Primary outcome
Stress ulcer prophylaxis drugs use
45.5%
49.5%
49.5 %
37.1 %
24.8 %
12.4 %
0.0 %
Pharmacist-led
intervention
Usual
care
Significant
decrease ▼
NNT = 25
Significant decrease in stress ulcer prophylaxis drugs use (45.5% vs. 49.5%; OR 0.81, 95% CI 0.68 to 0.96).
Secondary outcomes
No significant difference in overt gastrointestinal bleeding (3.7% vs. 4%; OR 1.05, 95% CI 0.65 to 2.85).
No significant difference in clinically important bleeding (1.1% vs. 0.8%; OR 1.09, 95% CI 0.68 to 1.74).
No significant difference in median length of ICU stay (100 hours vs. 100 hours; MD -0.061, 95% CI -0.55 to 0.42).
Safety outcomes
No significant differences in hospital-acquired pneumonia, death, C. difficile infection.
Conclusion
In adult patients receiving stress ulcer prophylaxis in the ICU, pharmacist-led intervention was superior to usual care with respect to stress ulcer prophylaxis drugs use.
Reference
Hailong Li, Linan Zeng, Peipei Xu et al. Effectiveness of a Pharmacist-Led Intervention to Reduce Acid Suppression Therapy for Stress Ulcer Prophylaxis in ICUs in China: A Multicenter, Stepped-Wedge, Cluster-Randomized Controlled Trial. Crit Care Med. 2025 Jan 31. Online ahead of print.
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