PURPOSE: Patients on mechanical ventilation (MV) are at increased risk of gastrointestinal bleeding (GIB). Proton pump inhibitors (PPIs), though more potent and longer acting inhibitors of gastric acid production, are generally more expensive than Histamine-2-Receptor Antagonists (an H2RA). Data comparing the two as prophylactic agents to prevent gastrointestinal bleeding in critically ill patients is limited. Our hypothesis is that Famotidine (an H2RA) is as effective as Pantoprazole (a PPI) in stress ulcer prophylaxis in mechanically ventilated patients.
METHODS: Data was collected from the Project Impact database. All patients mechanically ventilated > 48 hours from November 2002- June 2006 receiving either drug were analyzed. Patients receiving both drugs, with known GIB, thrombocytopenia, or coagulopathy were excluded.
RESULTS: 522 and 95 patients were included in the H2RA and PPI groups respectively. GIB (documented on upper endoscopy) was more common in the PPI group. While APACHE II scores were higher in the PPI group, there was no differences in the rate of ventilator associated pneumonia (diagnosis made by Bronchoalveolar lavage), duration of MV, ICU or hospital length of stay, or mortality between groups. GIB was more frequent among dialysis patients on PPI compared to those on H2RA.
CONCLUSION: GIB was significantly lower in the H2RA group with no identifiable difference in other outcome parameters. Acuity was higher in the PPI group, but this has not previously been linked to more frequent GIB. Our data suggests that in a diverse population of mechanically ventilated, critically ill patients, PPI offer no advantage over H2RA as prophylaxis against the development of upper gastrointestinal bleeding.
CLINICAL IMPLICATIONS: In the absence of convincing data supporting the use of a specific agent or class of agents, other factors such as cost, ease of administration, side effects and potential drug interactions should play an important role in choosing a therapy.
DISCLOSURE: Kizito Ojiako, No Financial Disclosure Information; No Product/Research Disclosure Information