261

Albert, Ben D.; Zurakowski, David; Bechard, Lori J.; Priebe, Gregory P.; Duggan, Christopher; Heyland, Daren K.; Mehta, Nilesh

doi:10.1097/01.ccm.0000474089.09012.10

Cited by 2 publications

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“…In critically ill adults, SUP has been associated with ventilator-associated pneumonia and Clostridioides difficile colitis (10,11). Similarly, in a large multicenter cohort we reported a significant association between SUP and ventilator-associated pneumonia in critically ill children (8). Several publications have also described an increase in bacteremia, necrotizing enterocolitis, and mortality in the neonatal ICU when patients were exposed to SUP (3,5,6).…”

supporting

confidence: 74%

“…However, the incidence of clinically significant UGI bleeds is very low, and there are limited data on the efficacy of SUP in critically ill infants and children (2). Furthermore, the safety and efficacy of SUP has been called into question even in adults over the last decade (3)(4)(5)(6)(7)(8).…”

mentioning

confidence: 99%

“…planned to undergo or recently has undergone gastrointestinal surgery within the last 4 weeks, (6) supported by ECMO or VAD,(7) currently enrolled in another conflicting interventional trial,(8) known to be allergic to H2RAs, (9) admitted for palliative care,(10) prior enrollment in the study, OR (11) primary provider declines enrollment. *CHD includes anatomic, myopathic and arrhythmic conditions ¶Respiratory support includes mechanical ventilation, non-invasive positive pressure ventilation, and high-flow oxygen therapy βStress ulcer prophylaxis or antacids includes H2RAs, PPIs, and sucralfate.…”

mentioning

confidence: 99%

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Stress Ulcer Prophylaxis versus Placebo - a Blinded Randomized Control Trial to Evaluate the Safety of Two Strategies in Critically Ill Infants with Congenital Heart Disease (SUPPRESS-CHD)

Mills

Albert

Bechard

et al. 2020

Preprint

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Abstract Background: Critically ill infants with congenital heart disease (CHD) are often prescribed stress ulcer prophylaxis (SUP) to prevent upper gastrointestinal bleeding, despite the low incidence of stress ulcers and limited data on the safety and efficacy of SUP in infants. Recently, SUP has been associated with an increased incidence of hospital-acquired infections, community-acquired pneumonia and necrotizing enterocolitis. The objective of this pilot study is to investigate the feasibility of performing a randomized controlled trial to assess the safety and efficacy of withholding SUP in infants with congenital heart disease admitted to the cardiac intensive care unit. Methods: A single center, prospective, double-blinded, randomized placebo-controlled pilot feasibility trial will be performed in infants with CHD admitted to the cardiac intensive care unit and anticipated to require respiratory support for > 24 hours. Patients will be randomized to receive a histamine-2 receptor antagonist (H2RA) or placebo until they are discontinued from respiratory support. Randomization will be performed within 2 strata defined by admission type (medical or surgical) and age (neonate, age <30 days, or infant, 1 month to 1 year). Allocation will be a 1:1 ratio using permuted blocks to ensure balanced allocations across the two treatment groups within each stratum. The primary outcomes include feasibility of screening, consent, timely allocation of study drug, and protocol adherence. The primary safety outcome is the rate of clinically significant upper gastrointestinal bleeding. The secondary outcomes are the difference in the relative and absolute abundance of the gut microbiota and functional microbial profiles between the two study groups. We plan to enroll 100 patients in this pilot study. Discussion: Routine use of SUP to prevent upper gastrointestinal bleeding in infants is controversial due to a low incidence of bleeding events and concern for adverse effects. The role of SUP in infants with CHD has not been examined and there is equipoise on the risks and benefits of withholding this therapy. In addition, this therapy has been discontinued in other neonatal populations due to the concern for hospital-acquired infections and necrotizing enterocolitis. Furthermore, exploring changes to the microbiome after exposure to SUP may highlight the mechanisms by which SUP impacts potential microbial dysbiosis of the gut and its association with hospital-acquired infections. Assessment of the feasibility of a trial of witholding SUP in critically ill infants with CHD will facilitate planning of a larger multicenter trial of safety and efficacy of SUP in this vulnerable population. Trial registration: NCT03667703; submitted September 12, 2018

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supporting

confidence: 74%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Stress Ulcer Prophylaxis versus Placebo - a Blinded Randomized Control Trial to Evaluate the Safety of Two Strategies in Critically Ill Infants with Congenital Heart Disease (SUPPRESS-CHD)

Mills

Albert

Bechard

et al. 2020

Preprint

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Risk factors of ventilator-associated pneumonia in children in an Egyptian University Children’s Hospital

Noaman

2021

Alexandria Journal of Pediatrics

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Aim To evaluate the risk factors that contribute to the development of ventilator-associated pneumonia (VAP) in children. Settings and design A prospective observational study was conducted. The study was done in pediatric intensive care unit (PICU) at Mansoura University Children’s Hospital, Egypt, over 1 year. The study included 154 patients. Patients and methods Many variables were analyzed such as demographic characteristics; previous hospital and PICU admission; drugs used such as inotropes, steroids, sedatives, H2 blockers, or proton pump inhibitors; nutritional therapies; chronic illnesses; invasive procedures such as central line insertion; duration of mechanical ventilation (MV); and PICU stay before development of VAP. Statistical analysis used All patients were assessed by Pediatric Risk of Mortality Score III in the first 24 h and evaluated for VAP by daily clinical examination and by radiological and laboratory evaluation. Results Duration of MV and PICU stay (before development of VAP) markedly increased the incidence of VAP (P value for both was <0.001). Steroid and sedative increased the incidence of VAP significantly (P=0.001 and 0.007, respectively). Conclusions Use of steroids and sedatives, prolonged MV, and length of PICU stay are the main risk factors that contribute toward the increased risk of VAP development in Mansoura University Children’s Hospital intensive care.

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261

Cited by 2 publications

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Stress Ulcer Prophylaxis versus Placebo - a Blinded Randomized Control Trial to Evaluate the Safety of Two Strategies in Critically Ill Infants with Congenital Heart Disease (SUPPRESS-CHD)

Stress Ulcer Prophylaxis versus Placebo - a Blinded Randomized Control Trial to Evaluate the Safety of Two Strategies in Critically Ill Infants with Congenital Heart Disease (SUPPRESS-CHD)

Risk factors of ventilator-associated pneumonia in children in an Egyptian University Children’s Hospital

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