Routine Use of Postoperative Acid Suppression (GI Prophylaxis) in Nona??Critically Ill Pediatric Appendectomy Patients

摘要

Overutilization of routine gastrointestinal (GI) prophylaxis has been a focus of research for more than a decade in North American and European countries given its potential to increase costs and cause adverse clinical effects.1,2 Prescription of antacids in inpatient units and their prolonged use cause changes in the intestinal microbiota with consequent increased risk for Clostridium difficile a??associated disease3a??5 and nosocomial pneumonia.1,2,6,7 According to the Choosing Wisely recommendation by the Society of Hospital Medicine, routine GI prophylaxis is not recommended for adults on general medical or surgical floors.8 The American Society of Health System Pharmacists a??Therapeutic Guidelines on Stress Ulcer Prophylaxisa?? state that patients admitted to the noncritical care hospital setting with 2 risk factors for bleeding should not receive routine stress ulcer prophylaxis.9 In pediatric patients, established risk factors for clinically significant stress ulcera??related bleeding and thus potential need for acid suppression include respiratory failure with the need for mechanical ventilation, coagulopathy, a Pediatric Risk of Mortality Score of a?￥10,10 shock, and thermal injuries.11,12 There is currently a paucity of formal guidelines on GI prophylaxis outside the ICU in pediatric patients. Whether GI prophylaxis is routinely a?|