Mark Borthwick
@markborthwick.bsky.social
Critical care pharmacist; what’s your poison….?
Awesome conference, so much good stuff :-)
November 14, 2025 at 8:42 PM
Awesome conference, so much good stuff :-)
My sincere thanks to all my critical care pharmacy colleagues for contributing data, and to UKCPA for the use of resources to make the study happen
May 27, 2025 at 7:31 PM
My sincere thanks to all my critical care pharmacy colleagues for contributing data, and to UKCPA for the use of resources to make the study happen
Overall we found the UK has moved over to using PPIs for SUP, there is some blanket prescribing going on, enteral feeding is commonly used as stopping criteria, though SUP is not stopped in some locations meaning deprescribing processes are needed
May 27, 2025 at 7:31 PM
Overall we found the UK has moved over to using PPIs for SUP, there is some blanket prescribing going on, enteral feeding is commonly used as stopping criteria, though SUP is not stopped in some locations meaning deprescribing processes are needed
Stopping criteria were dominated by “patient fed” (65% of units)
In three quarters of those, that meant “full enteral feed”, in the remaining quarter that largely meant “any enteral feed”.
Neither SUP-ICU, nor REVISE used enteral feeding as stopping criteria
In three quarters of those, that meant “full enteral feed”, in the remaining quarter that largely meant “any enteral feed”.
Neither SUP-ICU, nor REVISE used enteral feeding as stopping criteria
May 27, 2025 at 7:31 PM
Stopping criteria were dominated by “patient fed” (65% of units)
In three quarters of those, that meant “full enteral feed”, in the remaining quarter that largely meant “any enteral feed”.
Neither SUP-ICU, nor REVISE used enteral feeding as stopping criteria
In three quarters of those, that meant “full enteral feed”, in the remaining quarter that largely meant “any enteral feed”.
Neither SUP-ICU, nor REVISE used enteral feeding as stopping criteria
About a fifth of units reported they administered SUP to all patients, contrary to guidelines that advocate only giving SUP to critically ill patients with risk factors
May 27, 2025 at 7:31 PM
About a fifth of units reported they administered SUP to all patients, contrary to guidelines that advocate only giving SUP to critically ill patients with risk factors
Overall, we gathered information from over two thirds of UK critical care units, twice
Unsurprisingly, there was a large shift towards the use of PPIs for SUP between 2020 and 2024
Unsurprisingly, there was a large shift towards the use of PPIs for SUP between 2020 and 2024
May 27, 2025 at 7:31 PM
Overall, we gathered information from over two thirds of UK critical care units, twice
Unsurprisingly, there was a large shift towards the use of PPIs for SUP between 2020 and 2024
Unsurprisingly, there was a large shift towards the use of PPIs for SUP between 2020 and 2024
We gathered SUP practices again in 2024, just prior to the publication of REVISE (which had the potential to change practice again)
www.nejm.org/doi/abs/10.1...
www.nejm.org/doi/abs/10.1...
Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation | NEJM
Whether proton-pump inhibitors are beneficial or harmful for stress ulcer prophylaxis
in critically ill patients undergoing invasive ventilation is unclear. In this international,
randomized trial,...
www.nejm.org
May 27, 2025 at 7:31 PM
We gathered SUP practices again in 2024, just prior to the publication of REVISE (which had the potential to change practice again)
www.nejm.org/doi/abs/10.1...
www.nejm.org/doi/abs/10.1...
However, the appearance of COVID and the withdrawal of ranitidine somewhat ruined the experimental conditions
May 27, 2025 at 7:31 PM
However, the appearance of COVID and the withdrawal of ranitidine somewhat ruined the experimental conditions
We aimed to more completely characterise UK practice before the publication of PEPTIC (H2RA as first line SUP agent, or PPI as first line SUP agent)
We then wanted to see how or if practice would change after the publication of PEPTIC
jamanetwork.com/journals/jam...
We then wanted to see how or if practice would change after the publication of PEPTIC
jamanetwork.com/journals/jam...
Effect of Stress Ulcer Prophylaxis With PPIs vs H2RBs on ICU Mortality
This cluster randomized trial compares the effects of proton pump inhibitors (PPIs) vs histamine-2 receptor blockers (H2RBs) on 90-day mortality among patients requiring invasive mechanical ventilatio...
jamanetwork.com
May 27, 2025 at 7:31 PM
We aimed to more completely characterise UK practice before the publication of PEPTIC (H2RA as first line SUP agent, or PPI as first line SUP agent)
We then wanted to see how or if practice would change after the publication of PEPTIC
jamanetwork.com/journals/jam...
We then wanted to see how or if practice would change after the publication of PEPTIC
jamanetwork.com/journals/jam...
In the work up to SUP-ICU, an observational study recorded SUP practices across several countries
This revealed that unlike other countries, UK practice was divided between H2RA and PPIs
onlinelibrary.wiley.com/doi/abs/10.1...
This revealed that unlike other countries, UK practice was divided between H2RA and PPIs
onlinelibrary.wiley.com/doi/abs/10.1...
Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries
Background Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this st...
onlinelibrary.wiley.com
May 27, 2025 at 7:31 PM
In the work up to SUP-ICU, an observational study recorded SUP practices across several countries
This revealed that unlike other countries, UK practice was divided between H2RA and PPIs
onlinelibrary.wiley.com/doi/abs/10.1...
This revealed that unlike other countries, UK practice was divided between H2RA and PPIs
onlinelibrary.wiley.com/doi/abs/10.1...
Really interesting thread Segun
Balancing sufficient assurance of knowledge, skills, behaviours and experience vs overburdening is difficult, and key
We all -public, payers, colleagues- need some form of objective assurance of competence, not none
(in medicine, nursing, pharmacy, physio, etc)
Balancing sufficient assurance of knowledge, skills, behaviours and experience vs overburdening is difficult, and key
We all -public, payers, colleagues- need some form of objective assurance of competence, not none
(in medicine, nursing, pharmacy, physio, etc)
April 29, 2025 at 8:39 PM
Really interesting thread Segun
Balancing sufficient assurance of knowledge, skills, behaviours and experience vs overburdening is difficult, and key
We all -public, payers, colleagues- need some form of objective assurance of competence, not none
(in medicine, nursing, pharmacy, physio, etc)
Balancing sufficient assurance of knowledge, skills, behaviours and experience vs overburdening is difficult, and key
We all -public, payers, colleagues- need some form of objective assurance of competence, not none
(in medicine, nursing, pharmacy, physio, etc)