Histamine 2 Receptor Antagonist versus Proton Pump Inhibitors for the Prophylaxis of Stress Related Ulcers in the ICU Request: Which acid suppressant is better for prophylaxis of stress related ulcers in an intensive care setting, proton pump inhibitors (PPI’s) or histamine 2 receptor agonists (H2 Blockers)? Response: Background: Stress ulcers were first identified in 1970 by Skillman and Silen and reported as a clinical syndrome of lethal “stress ulceration” in a 7 out of 150 patients in intensive care (ICU). These reports showed superficial ulcers in the gastric fundus area of the stomach.1 Forty years later, Stress ulcers are still defined by distinct bleeding and interrupted circulation of blood to the fundus region. Skillman and …show more content…
Patients were included in the trial if they met the following criteria: Patients that were in the ICU receiving proton pump inhibitors, either enteral or parenteral, regardless of frequency, dose or duration. The control group is H2 blockers by enteral or parental routes, regardless of frequency, dose or duration. Patients had to be considered critically ill and have at least one risk factor for stress ulcers. Exclusion criteria were based on evaluation of the randomized trials done many years ago. Trials that were eliminated were based on duplication, trials that were not relevant to research, trial involving pediatric population, quasi-randomized trials, abstract trials, and observational …show more content…
Cochrane and CINHAL were also used in their search. Three trial registry web sites (clinicaltrials.gov, ISRCTN registry, and WHO) were also used. The searches were screened by two reviewers. Methodology was maintained by using Cochran’s risk of bias tool. Each trial used was rated as either, low risk, unclear or high risk for bias based on sequence generation, blinding, concealment sequence, selective reporting of outcomes, and data completeness. Relative risk (pooled) for all outcomes was calculated using a 95% confidence interval. I2 was used to measure heterogeneity. Event rates of 2% and 5% were used to identify the need for prophylaxis for bleeding and also overt bleeding with H2 blockers,
The Braden risk assessment tool was deemed to be appropriate due to the patient’s comorbidity’s of peripheral vascular disease and lymphoedema with the addition of an arterio-venous leg ulcer of the right leg. This scale is universally accepted as a tool to help identify those most at risk with a goal of allowing health care providers to use their experience and judgement to consistently reduce the risk or to ensure preventive care is appropriately prescribed (Guy, 2012). Pressure ulcers are a risk factor for those who suffer from
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
A pressure ulcer is an area of skin with unrelieved pressure resulting in ischemia, cell death, and necrotic tissue. The constant external pressure or rubbing that exceeds the arterial capillary pressure (32mmHg) and impairs local normal blood flow to tissue for an extended period of time, results in pressure ulcer (Smeltzer et. Al., 2013). According to National Pressure Ulcer Advisory Panel, 2014, pressure ulcers are a major burden to the society, as it approaches $11billion annually, with a cost range from $500 to $70,000 per individual pressure ulcer. It is a significant healthcare problem despite considerable investment in education, training, and prevention equipment. This paper includes two different studies to link cause-effect
Potter, J. E., White, K., Hopkins, K., Amastae, J., & Grossman, D. (2010). Clinic Versus Over-
Bowers, L., Allan, T., Simpson, A., Nijman, H., & Warren, J. (2007). Adverse Incidents, Patient
Are intubated patients placed at a greater chance of infection based on the initiation of parenteral verses enteral nutritional support?
Acid is produced naturally in your stomach to help you digest food and to kill bacteria. This acid irritates the stomach lining so our body produces a natural mucus barrier which protects it. Sometimes this barrier may be damaged thus allowing the acid to damage the stomach causing inflammation, ulcers and other conditions. Other times, there may be a problem with the muscular band at the top of the stomach that keeps the stomach tightly closed and this allows the acid to escape and irritate the oesophagus. This is called 'acid reflux' and can cause heartburn and/or oesophagitis. Proton pump inhibitors such as omeprazole stop cells in the lining of the stomach from producing too much acid. This can help prevent ulcers from forming or assist the healing process. By decreasing the amount of acid, they can also help to reduce acid reflux related symptoms such as heartburn.
... Clinical Evidence." Archives of Gynecology & Obstetrics 287.6 (2013): 1137-1149. Academic Search Premier. Web. 5 Oct. 2013.
For the process of formulating a PICO question I have narrowed down to five questions pertaining to the factors in the development of pressure ulcers. The first question is what role does the environment play i...
Registered Nurses Association of Ontario (RNAO). (2005). Best practice guideline (BPG): Risk assessment and prevention of ulcers. Retrieved from http:// www.rnao.org
Thomas, D. R. (2001). Issues and dilemmas in the prevention and treatment of pressure ulcers: A
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Sepsis is a life threating health condition and if not treated early can lead to shock, multiple organ failure and death (Ho, 2012). The main study of which practice has been based world-wide is the Surviving Sepsis Campaign. The Surviving Sepsis Campaign was developed to create evidence-based management guidelines. The Surviving Sepsis Campaign completed this by using an educational program to implement the guidelines by integrating their recommendations into resuscitation and management bundles (Marik, 2011). The first Surviving Sepsis Campaign Guidelines were published in Critical Care Medicine in 2004 with an updated version published in 2008 with the core of the recommendation's remained largely unchanged (Ahrens, 2011).
Turner, B. J., Newschaffer, C. J., Zhang, D., Fanning, T., & Hauck, W. W. (1999). Translating clinical trial results into practice. Annals of Internal Medicine, 130(12), 979-986.
The case under analysis, Eli Lilly & Company, will be covering the positives and negatives with regards to the business situation and strategy of Eli Lilly. One of the major pharmaceutical and health care companies in its industry, Lilly focused its efforts on the areas of "drug research, development, and marketed to the following areas: neuroscience, endocrinology, oncology, cardiovascular disease, and women's health." Having made a strong comeback in the 1990's due to its remarkably successful antidepressant Prozac, was now facing a potential loss in profits with its patent soon to expire. The problem was not only the soon to expire patent on Prozac, but the fact that Prozac accounted for as much as 30% of total revenue was the reality Eli Lilly now faced. (Pearce & Robinson, 34-1)