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Proton Pump Inhibitors vs. H 2 Blockers for Stress Ulcer Prophylaxis in ICU Patients: A Single Center, Retrospective Study of Comparative Outcomes of Clinical Efficacy and Adverse Effects FREE TO VIEW

Kashmira Singh, MD; James Walsh, MD
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Robert Packer Hospital/Guthrie Clinic, Sayre, PA

Chest. 2013;144(4_MeetingAbstracts):537A. doi:10.1378/chest.1704924
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SESSION TITLE: Cost and Quality Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: There remains conflicting evidence with limited data regarding the definite superiority of Proton Pump Inhibitors (PPI) over H 2 blockers in stress ulcer prophylaxis. More recent evidence suggests an association of PPI usage with undesirable clinical effects such as higher incidence of clostridium difficile diarrhea and ventilator associated pneumonia (VAP). In light of this evidence, coupled with higher costs associated with PPI use, we have retrospectively compared clinical outcomes in patients treated with a commonly used H2 Blocker; famotidine to patients treated with pantoprazole in an ICU setting.

METHODS: Institutional Review Board approval was obtained. We retrospectively analyzed data from 98 patients admitted to the ICU of a tertiary community hospital. Patients were divided into two groups as per the drug for stress ulcer prophylaxis: group 1: PPI group (n=48) and group 2: H2 blocker group (n=48) Following parameters were compared between the two groups using Fisher’s exact test: 1. Occurrence of gastrointestinal bleed. 2. Occurrence of clostridium difficile diarrhea. 3. Occurrence of ventilator associated pneumonia.

RESULTS: : The comparison of data showed that the incidence of gastrointestinal bleed was similar in both the groups (p=1). Also there was no statistically significant difference in the incidence of clostridium difficile diarrhea (p= 0.644) and ventilator associated pneumonia (p=0.778) in between the groups.

CONCLUSIONS: In this single center, observational study in a tertiary community hospital there was no significant difference in the incidence of gastrointestinal bleed, clostridium difficile diarrhea and ventilator associated pneumonia in ICU patients on PPI vs. those on H 2 blockers for stress ulcer prophylaxis.

CLINICAL IMPLICATIONS: Understanding the efficacy and adverse outcomes of stress ulcer prophylaxis agents will guide physicians to make a cost effective choice in managing critically ill patients and also validates the need for prospective trials comparing the same.

DISCLOSURE: The following authors have nothing to disclose: Kashmira Singh, James Walsh

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