Enquête nationale sur les pratiques de prophylaxie des hémorragies gastroduodénales en réanimation

Abstract

Aim: The aim of this study was to evaluate current practices for gastrointestinal bleeding prophylaxis in intensive care units (ICU) in France.

Methods: A descriptive transversal one given day survey was performed based on a national sample of adult ICUs. This survey focused on usual practices of gastrointestinal bleeding prophylaxis, and also on the type of preventive treatment in patients on prolonged mechanical ventilation (over 48 hours). A one-way analysis of variance was conducted, followed by a multivariate analysis, the results of which showed the main factors involved.

Results: One hundred and twenty-two ICUs participated in the survey, representing about 19% of the total amount of adult ICU beds. Of the 404 patients described, 268 (66.3%) received gastrointestinal bleeding prophylaxis on the day of the survey (omeprazole, 36.9%; ranitidine, 32.8%, or sucralfate, 30.2%). Preventive treatment was more common in medical or polyvalent units than in surgical ICUs (70.3% versus 55.2%; p < 0.01). The results did not show any association between the severity of the disease (estimated on an IGS II score basis) and the use of preventive treatment. Conversely, the latter was associated with the following factors: parenteral nutrition, shock, coagulopathy, history of gastrointestinal bleeding, and treatment with corticosteroids.

Conclusion: It was found that most ICUs in France use prophylactic treatment for the prevention of gastrointestinal bleeding. This probably helps to reduce the incidence of such cases.