PHARMACIST-LED INTERVENTIONS FOR RATIONAL STRESS-RELATED MUCOSAL DISEASE PROPHYLAXIS IN ICU:
AN INTEGRATIVE REVIEW
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https://doi.org/10.56579/rei.v7i4.1689Keywords:
Intensive Care, Deprescription, Patient Safety, Clinical Pharmacy, Stress-Related Mucosal InjuryAbstract
Introduction: Pharmacist interventions have been shown to enhance clinical outcomes in the prophylaxis of stress-related mucosal disease (SRMD) in intensive care units (ICUs) and to decrease hospital expenditures. This review aims to identify effective pharmacist strategies that mitigate the inappropriate utilization of proton pump inhibitors (PPIs) for the prophylaxis of acute gastric mucosal injury (AGMI) in ICU patients..Methods: An integrative review was conducted searching the following databases: VHL, LILACS, PubMed (MEDLINE), SciELO, Cochrane Library, and Google Scholar. The analysis focused on articles published over the last 5 years until November 2022. The study employed a descriptive approach to explore pharmaceutical interventions and their outcomes. Results: A total of 204 records were retrieved and 9 articles were included. Pharmaceutical interventions such as guidelines and protocols improved the clinical effectiveness of SRMD prophylaxis in ICUs, with appropriate prescriptions and adherence to guidelines. In addition to clinical benefits, these pharmacist-led interventions also significantly reduced monthly and annual costs. Conclusion: The participation of clinical pharmacists in the development of guidelines and protocols for SRMD prophylaxis, together with their presence in multidisciplinary rounds, appears to be the most effective strategy to improve outcomes. Nevertheless, further studies are necessary to assess the cost-effectiveness of this approach.
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AMIR, M.; KHAN, F. Role of clinical pharmacist in implementation of stress ulcer prophylaxis protocol: a single site retrospective study. RADS Journal of Pharmacy and Pharmaceutical Sciences, [S. l.], v. 9, n. 4, p. 225-230, 2021.
ANSTEY, M. H. et al. Clinical and economic benefits of de-escalating stress ulcer prophylaxis therapy in the intensive care unit: a quality improvement study. Anaesthesia and Intensive Care, [S. l.], v. 47, n. 6, p. 503-509, nov. 2019. DOI: 10.1177/0310057X19860972. DOI: https://doi.org/10.1177/0310057X19860972
ASHP – AMERICAN SOCIETY OF HEALTH-SYSTEM PHARMACISTS. ASHP therapeutic guidelines on stress ulcer prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. American Journal of Health-System Pharmacy, [S. l.], v. 56, n. 4, p. 347-379, 15 fev. 1999. DOI: 10.1093/ajhp/56.4.347. DOI: https://doi.org/10.1093/ajhp/56.4.347
BAZAN, N. S.; FARID, S. F.; BAINES, D. L. Impact of clinical pharmacists on adherence to stress ulcer prophylaxis protocol in critically ill Egyptian patients: a comparative study. Drugs and Therapy Perspectives, [S. l.], v. 37, p. 35–43, 2021. DOI: https://doi.org/10.1007/s40267-020-00786-y. DOI: https://doi.org/10.1007/s40267-020-00786-y
BARLETTA, J. F. et al. Stress ulcer prophylaxis. Critical Care Medicine, [S. l.], v. 44, n. 7, p. 1395-1405, jul. 2016. DOI: 10.1097/CCM.0000000000001872. DOI: https://doi.org/10.1097/CCM.0000000000001872
BEN-MENACHEM, T. et al. Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit: a randomized, controlled, single-blind study. Annals of Internal Medicine, [S. l.], v. 121, n. 8, p. 568-575, 15 out. 1994. DOI: 10.7326/0004-819-121-8-199410150-00003. DOI: https://doi.org/10.7326/0003-4819-121-8-199410150-00003
BROWN, D. A review of the PubMed PICO tool: using evidence-based practice in health education. Health Promotion Practice, [S. l.], v. 21, n. 4, p. 496-498, jul. 2020. DOI: 10.1177/1524839919893361. DOI: https://doi.org/10.1177/1524839919893361
CEEINTER. Centro de Estudos Interdisciplinares Página Inicial. [S.l.]. Florianópolis, c2023. Disponível em: https://portal.ceeinter.com.br/. Acesso em: 10 de set. 2023.
COOK, D. J. et al. Risk factors for gastrointestinal bleeding in critically ill patients. The New England Journal of Medicine, [S. l.], v. 330, n. 6, p. 377-381, 10 fev. 1994. DOI: 10.1056/NEJM199402103300601. DOI: https://doi.org/10.1056/NEJM199402103300601
COOK, D. J. et al. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Critical Care, [S. l.], v. 5, n. 6, p. 368-375, dez. 2001. DOI: 10.1186/cc1071. DOI: https://doi.org/10.1186/cc1071
FRANCHITTI, M. et al. Adequacy of stress ulcer prophylaxis prescription in the intensive care unit: an observational study. Swiss Medical Weekly, [S. l.], v. 150, p. w20322, 24 ago. 2020. DOI: 10.4414/smw.2020.20322. DOI: https://doi.org/10.4414/smw.2020.20322
GUILLAMONDEGUI, O. D. et al. Practice management guidelines for stress ulcer prophylaxis. Chicago, IL: Eastern Association for the Surgery of Trauma, 2008. 24 p.
GRUBE, R. R.; MAY, D. B. Stress ulcer prophylaxis in hospitalized patients not in intensive care units. American Journal of Health-System Pharmacy, [S. l.], v. 64, n. 13, p. 1396-1400, 1 jul. 2007. DOI: 10.2146/ajhp060393. DOI: https://doi.org/10.2146/ajhp060393
HAASE, N. et al. Bleeding and risk of death with hydroxyethyl starch in severe sepsis: post hoc analyses of a randomized clinical trial. Intensive Care Medicine, [S. l.], v. 39, n. 12, p. 2126-2134, dez. 2013. DOI: 10.1007/s00134-013-3111-9. DOI: https://doi.org/10.1007/s00134-013-3111-9
HATCH, J. B.; SCHULZ, L.; FISH, J. T. Stress ulcer prophylaxis: reducing non-indicated prescribing after hospital discharge. Annals of Pharmacotherapy, [S. l.], v. 44, n. 10, p. 1565-1571, out. 2010. DOI: 10.1345/aph.1P167. DOI: https://doi.org/10.1345/aph.1P167
HONG, Y. et al. Continuous improvement on the rationality of prophylactic injectable PPIs usage by a clinical pharmacist-led guidance team at a Chinese tertiary teaching hospital. Journal of International Medical Research, [S. l.], v. 48, n. 10, p. 1-10, out. 2020. DOI: 10.1177/0300060520954729. DOI: https://doi.org/10.1177/0300060520954729
KRAG, M. et al. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Medicine, [S. l.], v. 41, n. 5, p. 833-845, maio 2015. DOI: 10.1007/s00134-015-3725-1. DOI: https://doi.org/10.1007/s00134-015-3725-1
LUO, H. et al. Changes in proton pump inhibitor prescribing trend over the past decade and pharmacists' effect on prescribing practice at a tertiary hospital. BMC Health Services Research, [S. l.], v. 18, n. 1, p. 537, 11 jul. 2018. DOI: 10.1186/s12913-018-3358-5. DOI: https://doi.org/10.1186/s12913-018-3358-5
MADSEN, K. R. et al. Guideline for stress ulcer prophylaxis in the intensive care unit. Danish Medical Journal, [S. l.], v. 61, n. 3, p. C4811, mar. 2014. PMID: 24814922. Disponível em: https://ugeskriftet.dk/dmj/guideline-stress-ulcer-prophylaxis-intensive-care-unit. Acesso em: 17 jul. 2025.
MAHMOUDI, L.; MOHAMMADI, R.; NIKNAM, R. Economic impact of pharmacist interventions on correction of stress-related mucosal damage prophylaxis practice. ClinicoEconomics and Outcomes Research, [S. l.], v. 11, p. 111-116, 25 jan. 2019. DOI: 10.2147/CEOR.S191304. DOI: https://doi.org/10.2147/CEOR.S191304
MASOOD, U. et al. A successful pharmacist-based quality initiative to reduce inappropriate stress ulcer prophylaxis use in an academic medical intensive care unit. Inquiry, [S. l.], v. 55, p. 1-6, jan./dez. 2018. DOI: 10.1177/0046958018759116. DOI: https://doi.org/10.1177/0046958018759116
MOUSAVI, M. et al. Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency. International Journal of Pharmacy Practice, [S. l.], v. 21, n. 4, p. 269, ago. 2013. DOI: 10.1111/ijpp.12005. DOI: https://doi.org/10.1111/ijpp.12005
MUÑOZ-PICHUANTE, D.; VILLA-ZAPATA, L. Benefit of incorporating clinical pharmacists in an adult intensive care unit: a cost-saving study. Journal of Clinical Pharmacy and Therapeutics, [S. l.], v. 45, n. 5, p. 1127-1133, out. 2020. DOI: 10.1111/jcpt.13195. DOI: https://doi.org/10.1111/jcpt.13195
ORLANDO REGIONAL MEDICAL CENTER. Stress ulcer prophylaxis. 2011. Disponível em: http://www.surgicalcriticalcare.net/Guidelines/stress%20ulcer%20prophylaxis%202011.pdf. Acesso em: 17 jul. 2025.
PATI, D.; LORUSSO, L. N. How to write a systematic review of the literature. HERD: Health Environments Research & Design Journal, [S. l.], v. 11, n. 1, p. 15-30, jan. 2018. DOI: 10.1177/1937586717747384. DOI: https://doi.org/10.1177/1937586717747384
PHAM, C. Q. et al. Acid suppressive therapy use on an inpatient internal medicine service. Annals of Pharmacotherapy, [S. l.], v. 40, n. 7-8, p. 1261-1266, jul./ago. 2006. DOI: 10.1345/aph.1G703. DOI: https://doi.org/10.1345/aph.1G703
RHODES, A. et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine, [S. l.], v. 43, n. 3, p. 304-377, mar. 2017. DOI: 10.1007/s00134-017-4683-6. DOI: https://doi.org/10.1007/s00134-017-4683-6
SAVARINO, V. et al. Proton pump inhibitors: use and misuse in the clinical setting. Expert Review of Clinical Pharmacology, [S. l.], v. 11, n. 11, p. 1123-1134, nov. 2018. DOI: 10.1080/17512433.2018.1531703. DOI: https://doi.org/10.1080/17512433.2018.1531703
SCHOENFELD, A. J.; GRADY, D. Adverse effects associated with proton pump inhibitors. JAMA Internal Medicine, [S. l.], v. 176, n. 2, p. 172-174, fev. 2016. DOI: 10.1001/jamainternmed.2015.7927. DOI: https://doi.org/10.1001/jamainternmed.2015.7927
VANDERBILT UNIVERSITY MEDICAL CENTER. Gastrointestinal stress ulcer prophylaxis guideline. 2005. Disponível em: http://traumaburn.com/Protocols/StressUlcerProphylaxisVisio.pdf. Acesso em: 17 jul. 2025.
WELLS, G. A. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. [S. l.], [s. n.], [20--]. Disponível em: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Acesso em: 30 ago. 2023.
YAILIAN, A. L. et al. Characteristics of pharmacists' interventions related to proton-pump inhibitors in French hospitals: an observational study. International Journal of Clinical Practice, [S. l.], v. 2022, p. 9619699, 28 jun. 2022. DOI: 10.1155/2022/9619699. DOI: https://doi.org/10.1155/2022/9619699
YE, Z. et al. Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline. BMJ, [S. l.], v. 368, p. l6722, 6 jan. 2020. DOI: 10.1136/bmj.l6722. DOI: https://doi.org/10.1136/bmj.l6722
ZANDSTRA, D. F.; STOUTENBEEK, C. P. The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without any prophylaxis: a prospective cohort study. Intensive Care Medicine, [S. l.], v. 20, n. 5, p. 335-340, maio 1994. DOI: 10.1007/BF01720905. DOI: https://doi.org/10.1007/BF01720905
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