PURPOSE: To compare the efficacy of IV proton pump inhibitors (PPI) and IV H2-blockers (H2B) in preventing stress ulcer bleeding (SUB) in critically ill patients. Also to investigate the risk of hospital acquired pneumonia (HAP) associated with IV-PPI compared to IV-H2B.
METHODS: Retrospective analysis of clinically significant upper gastrointestinal bleeding in critically ill patients, treated by IV-PPI or IV-H2B as a prophylaxis during their ICU stay. Critically ill patients who were admitted to ICU and required SUB prophylaxis over one year period were included. Excluding patients who were admitted for upper or lower gastro-intestinal bleeding (GIB), end stage liver disease or known cause of upper GIB. Patients charts were randomly selected and reviewed for risk factors, type of SUB prophylaxis and clinically significant upper GI bleeding episodes. Also episodes of HAP were noted.
RESULTS: 158 patients included with mean age of 62.5 and 48% female. 93% were African American. All patients received SUB prophylaxis during ICU stay. 80 patients received IV-PPI and 78 received IV-H2B. The two groups were matched for severity of illness using APACHE II score. The rate of clinically significant SUB was 2.50% in IV-PPI group versus 5.12% in IV-H2B group (P=0.02). None of the patients died of bleeding complication in both groups. The incidence of HAP was similar in both groups (11.5%).
CONCLUSION: IV-PPI is more effective than IV-H2B in critically ill patients for SUB prophylaxis. IV-PPI is not associated with increased risk of HAP compare to H2B.
CLINICAL IMPLICATIONS: IV-PPI should be the medication of choice for critically ill patients requiring SUB prophylaxis during their ICU stay.
DISCLOSURE: Farzad Malekanian, None.