Comparative Effectiveness of Proton Pump Inhibitors vs Histamine Type 2 Receptor Blockers for Preventing Clinically Important Gastrointestinal Bleeding During Intensive Care

Lilly, Craig M.; Aljawadi, Mohammad; Badawi, Omar; Onukwugha, E.; Tom, Sarah E.; Magder, Laurence S.; Harris, Ilene

doi:10.1016/j.chest.2018.05.015

Cited by 27 publications

(41 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…24–26 Some previous studies have shown conflicting results regarding the efficacy of PPIs and H 2 RAs for stress ulcer prophylaxis. 7 27 In the present study, we found no significant difference in C. difficile infection rates between patients receiving PPIs versus H 2 RAs for stress ulcer prophylaxis. Previous studies showed that stress ulcer medical prophylaxis increased the risk of C. difficile infection, but it remains unclear whether the risk of C. difficile infection differs between patients receiving PPIs versus H 2 RAs.…”

Section: Discussioncontrasting

confidence: 57%

“… 6 In 2018, a larger observational study showed that PPIs were associated with a higher risk of CIGIB compared with H 2 RAs in critically ill patients. 7 A recent randomised controlled trial showed no difference in CIGIB between PPIs and H 2 RAs 8 ; however, to our knowledge, no previous study has assessed the superiority of PPIs over H 2 RAs in patients receiving ECMO.…”

Section: Purposementioning

confidence: 93%

See 1 more Smart Citation

Proton pump inhibitors versus histamine-2 receptor antagonists for stress ulcer prophylaxis during extracorporeal membrane oxygenation: a propensity score-matched analysis

et al. 2020

View full text Add to dashboard Cite

PurposePatients receiving extracorporeal membrane oxygenation (ECMO) generally receive proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) to avoid major gastrointestinal bleeding. Our aim was to compare outcomes between patients receiving PPIs and H2RAs for stress ulcer prophylaxis during ECMO.Materials and methodsWe performed a retrospective cohort study using the Japanese Diagnosis Procedure Combination Database, using data recorded from 1 July 2010 to 31 March 2017. We defined patients who received PPIs within 2 days after starting ECMO as the PPIs group and those who received H2RAs within 2 days after starting ECMO as the H2RAs group. We performed propensity score matching to compare outcomes. The primary outcomes were gastrointestinal bleeding requiring endoscopic haemostasis and in-hospital mortality. The secondary outcomes were red blood cell transfusion, hospital-acquired pneumonia and Clostridium difficile infection during hospitalisation.ResultsOf 11 328 eligible patients, 9738 received PPIs and 1590 received H2RAs. Propensity score matching created 1556 pairs. No significant differences were seen regarding endoscopic haemostasis (1.2% vs 0.8%; p=0.37), in-hospital mortality (53.0% vs 53.1%; p=0.94), red blood cell transfusion rates (91.4% vs 89.7%; p=0.11), hospital-acquired pneumonia (13.0% vs 12.4%; p=0.59) or C. difficile infection (0.1% vs 0.2%; p=0.32) between the PPIs and H2RAs groups, respectively.ConclusionWe found no differences in the evaluated outcomes between the PPIs and H2RAs groups. Both PPIs and H2RAs are treatment options for stress ulcer prophylaxis in patients undergoing ECMO.

show abstract

Section: Discussioncontrasting

confidence: 57%

Section: Purposementioning

confidence: 93%

Proton pump inhibitors versus histamine-2 receptor antagonists for stress ulcer prophylaxis during extracorporeal membrane oxygenation: a propensity score-matched analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A recent multicenter retrospective study examined the effect of preventing clinically important GI bleeding (CIGIB) with prophylactic PPIs or H2RA among critically ill adults with at least one stress ulcer risk factor in ICU care in US nonfederal hospitals. They found the hazard ratio for CIGIB was two times greater for PPIs patients than for H2RA patients (adjusted HR 1.82 [95% CI, 1.19-2.78]) (Lilly et al, 2018). H2RA administration has been associated with many rare side effects (cardiac arrhythmia; cardiac arrest occurring with rapid infusion (Hinrichsen et al, 1995;Lee et al, 2004); increases in serum creatinine observed with cimetidine; immune-mediated interstitial nephritis; both cholestatic and hepatocellular injury (Fisher and Le Couteur, 2001); CNS side effects including confusion, restlessness, somnolence, agitation, headaches, dizziness, and hallucinations and seizures with prolonged therapy (Cantu and Korek, 1991); and B12 deficiency with long-term H2RA use (Lam et al, 2013); however, many of these adverse effects are rapidly reversible or resolve after withdrawal of the drug (Fisher and Le Couteur, 2001).…”

Section: Discussionmentioning

confidence: 99%

Association Between Proton Pump Inhibitors and Asthma: A Population-Based Cohort Study

2020

View full text Add to dashboard Cite

Objective: The relationship between proton pump inhibitors (PPIs) and asthma is controversial. The goal of this study was to determine the association between PPI use in non-asthma subjects and their subsequent asthma prevalence. Design: Nationwide, population-based cohort study. Methods: We conducted a nationwide, population-based retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) of Taiwan from 1999 to 2013. We identified 24,077 adult patients with PPI use for more than 3 months and 24,077 controls matched by propensity score on a one-to-one ratio for age, gender, comorbidities (hypertension, hyperlipidemia, gastroesophageal reflux disease, allergic rhinitis, atopic dermatitis, peptic ulcer disease, diabetes, and sleep apnea syndrome), and medications (histamine 2 receptor antagonists [H2RA], nonsteroidal anti-inflammatory drugs [NSAIDs], and acetaminophen). The cumulative asthma incidence for the two cohorts in the follow-up period was estimated with the Kaplan-Meier method, and the difference was examined using the log-rank test. Multivariate Cox regression models were used to calculate the adjusted hazard ratios (HR). Results: The overall incidence of asthma was 1.58-fold greater in the PPI cohort than in the non-PPI cohort (13.3 versus 8.4 per 1,000 person-years), with an adjusted HR of 1.76 (95% confidence interval [CI], 1.64-1.88). In patients without previous peptic ulcer disease, the adjusted HR of asthma associated with PPIs was higher than in the non-PPI group (1.95; 95% CI, 1.80-2.11). The risk of asthma due to PPI use was also more significant in patients not receiving H2RA (

show abstract

“…16 However, H2RAs may be associated with a lower incidence of Clostridium difficile infections, hospital acquired pneumonia, and ventilator associated pneumonia compared with PPIs. [17][18][19][20] The final modification to the order set was made to facilitate prescribing of lactated ringers over normal saline. Two studies published in the New England Journal of Medicine in 2018 showed the use of balanced crystalloid solutions, such as lactated ringers and plasma-lyte A, in both critically ill and noncritically ill patients, resulted in a significantly lower incidence of major adverse kidney events within 30 days.…”

Section: Background and Significancementioning

confidence: 99%

“…Two studies published in the New England Journal of Medicine in 2018 showed the use of balanced crystalloid solutions, such as lactated ringers and plasma-lyte A, in both critically ill and noncritically ill patients, resulted in a significantly lower incidence of major adverse kidney events within 30 days. 20,21 Furthermore, unlike balanced crystalloid solutions, fluid resuscitation with normal saline has been associated with hyperchloremic metabolic acidosis, which can lead to several adverse effects including renal vasoconstriction, reduced gastric perfusion, and increased release of inflammatory markers. [23][24][25] The IP CC Admit Order Set is primarily used by rotating medical residents admitting patients to the medical intensive care unit (MICU) at our health system's largest institution.…”

Section: Background and Significancementioning

confidence: 99%

The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

2020

View full text Add to dashboard Cite

Background Implementation of disease-specific order sets has improved compliance with standards of care for a variety of diseases. Evidence of the impact admission order sets can have on care is limited. Objective The main purpose of this article is to evaluate the impact of changes made to an electronic critical care admission order set on provider prescribing patterns and clinical outcomes. Methods A retrospective, observational before-and-after exploratory study was performed on adult patients admitted to the medical intensive care unit using the Inpatient Critical Care Admission Order Set. The primary outcome measure was the percentage change in the number of orders for scheduled acetaminophen, a histamine-2 receptor antagonist (H2RA), and lactated ringers at admission before implementation of the revised order set compared with after implementation. Secondary outcomes assessed clinical impact of changes made to the order set. Results The addition of a different dosing strategy for a medication already available on the order set (scheduled acetaminophen vs. as needed acetaminophen) had no impact on physician prescribing (0 vs. 0%, p = 1.000). The addition of a new medication class (an H2RA) to the order set significantly increased the number of patients prescribed an H2RA for stress ulcer prophylaxis (0 vs. 20%, p < 0.001). Rearranging the list of maintenance intravenous fluids to make lactated ringers the first fluid option in place of normal saline significantly decreased the number of orders for lactated ringers (17 vs. 4%, p = 0.005). The order set changes had no significant impact on clinical outcomes such as incidence of transaminitis, gastrointestinal bleed, and acute kidney injury. Conclusion Making changes to an admission order set can impact provider prescribing patterns. The type of change made to the order set, in addition to the specific medication changed, may have an effect on how influential the changes are on prescribing patterns.

show abstract

Comparative Effectiveness of Proton Pump Inhibitors vs Histamine Type 2 Receptor Blockers for Preventing Clinically Important Gastrointestinal Bleeding During Intensive Care

Abstract: H2Bs were robustly and consistently associated with significantly lower CIGIB risk compared with PPIs in this population.

Cited by 27 publications

References 28 publications

Proton pump inhibitors versus histamine-2 receptor antagonists for stress ulcer prophylaxis during extracorporeal membrane oxygenation: a propensity score-matched analysis

Proton pump inhibitors versus histamine-2 receptor antagonists for stress ulcer prophylaxis during extracorporeal membrane oxygenation: a propensity score-matched analysis

Association Between Proton Pump Inhibitors and Asthma: A Population-Based Cohort Study

The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

Contact Info

Product

Resources

About