Stress ulcer prophylaxis practice in UK critical care units : a comparison of cross-sectional surveys between 2020 and 2024
Borthwick, Mark Barton, Greg Boxall, Emma Dade, John P Farrell, Odran Forrest, Ruth Graham-Clarke, Emma Kean, David Leigh, Helen Mehta, Reena
Borthwick, Mark
Barton, Greg
Boxall, Emma
Dade, John P
Farrell, Odran
Forrest, Ruth
Graham-Clarke, Emma
Kean, David
Leigh, Helen
Mehta, Reena
Affiliation
Oxford University Hospitals NHS Foundation Trust; Mersey and West Lancashire Teaching Hospitals NHS Trust; Northern Care Alliance NHS Foundation Trust; Sandwell and West Birmingham nHS Trust; et al.
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Publication date
2025-05-26
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Abstract
Background: Critically ill patients are at risk of bleeding from stress ulcers. Comprehensive information regarding United Kingdom stress ulcer prophylaxis (SUP) practices are not available and may change over time. We aimed to describe SUP practices in 2020 and reevaluate the position in 2024. Methods: Critical care pharmacists provided observed SUP practice data for UK adult critical care units via an electronic repository in 2020 and 2024. One response was accepted from each critical care unit at each time point. Data collected included trigger criteria for commencing SUP, primary medication class used, primary SUP cessation criteria, and level of nutritional intake (if part of cessation criteria). Results: There were high response rates of 70.3% (2020) and 66.7% (2024) of registered UK adult critical care units. Few differences in primary SUP trigger criteria between 2020 and 2024 were seen, with small differences in the categories of 'SUP not used' (p = 0.002) and 'Shock' (p = 0.027) driving statistical significance (χ2(7, 454) = 16.76, p = 0.019). There was a significant change in the primary medication class used for SUP (H2 receptor antagonist 49.4% 2020, vs 0.4% 2024, proton pump inhibitor 44.7% 2020 vs 97.8% 2024; χ2(2, 458) = 159.62, p < 0.001). Primary SUP cessation criteria was 'Patient fed' (66.8% 2020, 64.6% 2024), with most describing this threshold as met when the patient receives full enteral feed (72.0% 2020, 78.8% 2024). Conclusion: The UK has moved towards proton pump inhibitors as the primary SUP medication class. SUP is most frequently discontinued on establishment of enteral nutrition.
Citation
Borthwick M, Barton G, Boxall E, Dade JP, Farrell O, Forrest R, Graham-Clarke E, Kean D, Leigh H, Mehta R, Mulherron G, Roadley-Battin R, Sapsford D, Timmins A, Warburton J, Bourne RS. Stress ulcer prophylaxis practice in UK critical care units: A comparison of cross-sectional surveys between 2020 and 2024. J Intensive Care Soc. 2025 May 26:17511437251338614. doi: 10.1177/17511437251338614. Epub ahead of print
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Article