Characterization of the use of acid-suppressive therapy for stress ulcer prophylaxis in pediatric intensive care unit (ICU) patients: a retrospective, single-center study

Abstract

Introduction: Acid-suppressive drugs are routinely prescribed prophylactically in children admitted to the pediatric intensive care units (PICUs) to reduce the incidence of gastrointestinal bleeding; however, there is constrasting evidence and no universally accepted guidelines on the administration of stress ulcer prophylaxis (SUP) in this specific patient group. The present study aimed to assess the characteristics and appropriateness of SUP in the PICU of Shifa International Hospital (SIH), Islamabad, Pakistan.
Methodology: A retrospective, descriptive cross-sectional study was carried out, involving the medical records of critically ill children admitted between the time period of January 2020 to December 2022. Data collection was performed using a pre-designed checklist, with main areas including demographic characteristics, relevant diagnoses, treatments and prophylactic medications, medications used and duration of SUP, and adverse events.
Results: Out of the n=727 children admitted, n=588 (80.9%) patients met the inclusion criteria of the study. Mean age of the patients in the study was 6.58 years (range: 4 months – 17 years), with a majority of males (n=357; 60.7%). Mean length of PICU stay was 9.28 days (range: 1-20 days); 44.1% of PICU patients had a length of stay of ≥5 days. Most pediatric patients were admitted to the PICU due to respiratory (n=120; 20.4%) and neurological (n=112; 19.0%). illnesses. 61.4% (n=361) of children admitted received an acid suppressant throughout their PICU stay, with n=256 (70.9%) received the drug only for the duration of their hospital stay. 55.9% of patients receiving non-steroidal anti-inflammatory drugs, 57.0% on systemic steroids, 63.5% on sedatives, 68.8% on anti-epileptics, 70.0% on antibiotics, 83.3% on antifungals and 100.0% of patients receiving anticoagulants also had SUP prescribed as well. No case of clinically-relevant gastrointestinal bleeding was observed.
Conclusions: The frequency and use of different classes of SUP among children, as well as possible facilitators for their prescribing in PICUs were assessed. Acid suppressive drugs in the PICUs are still crucial component in the treatment plan. Our results suggest the need to introduce evidence-based protocols, both locally and internationally, to avoid the unnecessary use of SUP, especially in the context of possible adverse events associated with their use over an extended period of time or the impact of acid suppression on gut health.