Case Report: The Effect of Proton Pump Inhibitor Administration on Hemodynamics in a Cardiac Intensive Care Unit

Abstract

Ex vivostudies have suggested that high dose proton pump inhibitors (PPI) may have negative inotropic effects in myocardial tissue. We sought to investigate this concept in a real-world clinical setting. In this case series, we enrolled critically ill patients in the coronary and cardiothoracic intensive care units who had a preexisting pulmonary artery (PA) catheter in place for hemodynamic monitoring and were on a PPI for prespecified clinical indications. Hemodynamic measurements were made at baseline and then at 15 minute intervals for 1 hour after PPI administration. A total of 18 patients were evaluated; 72% were male with a mean age of 59.9 years. A total of 9 patients were evaluated on 2 consecutive days, yielding 26 patient-exposures to the medication. The majority of patients (72%) were receiving 1 or more inotropic agents (n = 6), a vasopressor (n = 4), or both (n = 4). When compared to baseline values, there was no significant change in mean arterial pressure (baseline 80 ± 11 mm Hg), heart rate (87 ± 11 bpm), or Fick cardiac index (2.7 ± 1.8 L/min/m 2 ). Mean PA pressure did decrease transiently at 45 minutes following PPI administration (28.5 ± 7.7 mm Hg at baseline vs 26.5 ± 7.5 mm Hg, P = 0.017), but is unlikely to be of clinical significance. In conclusion, these data suggest that IV PPIs do not immediately impact important hemodynamic parameters and are likely safe in a high-risk intensive care setting.