P4186 - Managing Stress Ulcers in the ICU: What Medical Residents Know and Do

Tolga Gidener, MD¹, Justin Chung, MD², Qi Yu, MD, MPH^3
1SUNY Downstate, Brooklyn, NY; ²SUNY Downstate Health Sciences University, Brooklyn, NY; ³SUNY Downstate Health Sciences University/NYCHHC Kings County Hospital, Brooklyn, NY

Introduction: Critically ill patients in intensive care units (ICU) are at high risk of stress ulcers and ulcer-related bleeding. Proton pump inhibitors (PPIs) are commonly used to prevent acid production in the ICU setting, but there is a lack of clear guidelines regarding patient selection, intensity, timing, and de-escalation of therapy. This variability in practice influences how residents learn to prescribe PPIs for stress ulcer prophylaxis (SUP).

Methods: To address this issue, we conducted a survey of 184 internal medicine (IM) residents across three teaching hospitals to evaluate their knowledge, practices, and concerns regarding PPI use for SUP.

Results: The response rate to the survey was 33%. Among the 60 respondents, 93% (n=56) preferred PPIs for SUP, while only 5% preferred H2-blockers, and 2% did not prefer any medication. 65% of the residents prescribed PPIs to mechanically ventilated and critically ill patients, 22% prescribed them only to mechanically ventilated patients, and 10% prescribed them to every patient in the ICU. The majority of the respondents (90%) had been taught that PPIs are the preferred agent for SUP, while 5% had been taught that H2-blockers were preferred, and another 5% was not sure and deferred the decision to the attending.









When it came to side effects of PPIs, 34 residents (57%) were concerned about C. difficile infection. Other concerns included drug-drug interactions or polypharmacy (13%), kidney injury, pneumonia, malabsorption, or other side effects (22%), and 8% reported no concerns. For H2-blockers, the most concerning side effects were CNS effects (17%) and polypharmacy (32%). On the other hand, 32% of the respondents were not concerned about any side effects of H2-blockers. Regarding discontinuation of PPIs, 60% of the respondents reported that they discontinue PPIs once patients are not considered 'high risk' in the ICU, while 17% preferred to discontinue them after ICU downgrade, and 8% after discharge.

Discussion: Our study highlights the knowledge gaps, concerns, and common practices in using PPIs for SUP among IM residents in a large academic program across three different sites. The variability of practice and knowledge gaps can be addressed through quality improvement projects, educational interventions, and hospital-wide policy changes.









Disclosures:


Tolga Gidener, MD¹, Justin Chung, MD², Qi Yu, MD, MPH³. P4186 - Managing Stress Ulcers in the ICU: What Medical Residents Know and Do, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.