Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients

Conrad, Steven A.; Gabrielli, A.; Margolis, Benjamin D.; Quartin, Andrew A.; Hata, J. Steven; Frank, William O.; Bagin, Robert; Rock, James A.; Hepburn, Bonnie; Laine, Loren

doi:10.1097/01.ccm.0000157751.92249.32

Cited by 134 publications

(107 citation statements)

References 18 publications

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“…In a recent randomised trial with 359 patients, no significant differences were observed in the rate of clinically significant bleeding between the patients who received omeprazole oral suspension and i.v. cimetidine [186]. Thus, the present authors believe that stress bleeding prophylaxis can be obtained without increasing the risk of VAP with use of histamine-2 receptor antagonists, sucralfate or protonpump inhibitors.…”

Section: Stress Ulcer Prophylaxismentioning

confidence: 94%

“…Limited data exist on its clinical efficacy; however, available data indicate that proton-pump inhibitors can be efficacious [182][183][184][185][186]. In two prospective series of patients receiving omeprazole oral suspension [182,183], with sizes of 75 and 60 patients, respectively, clinically significant gastrointestinal bleeding was not experienced.…”

Section: Stress Ulcer Prophylaxismentioning

confidence: 99%

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Evidence on measures for the prevention of ventilator-associated pneumonia

Lorente

Blot²,

Rello³

2007

Eur Respir J

136

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Section: Stress Ulcer Prophylaxismentioning

confidence: 94%

Section: Stress Ulcer Prophylaxismentioning

confidence: 99%

Evidence on measures for the prevention of ventilator-associated pneumonia

Lorente

Blot²,

Rello³

2007

Eur Respir J

136

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“…This type of ulcer lead to clinically significant bleeding in 3-6% of patients, clinically characterized, 24 hours after the onset of ulceration, by decrease equal or greater than 20 mmHg in systolic blood pressure when the patient is bedridden; increased heart rate by 20 beats/min and decreased systolic blood pressure by 10 mmHg when the patient is upright; and also, a decrease in hemoglobin of at least 2 g/dL [22].…”

Section: Discussionmentioning

confidence: 99%

“…When prolonged, this gastric hypoperfusion and consequent reduction in oxygen supply decrease the secretion of bicarbonate and mucus in the stomach, besides reducing gastric motility. These effects of the GI tract, make it more susceptible to the corrosive action of pepsin and other bile acids, leading to ulceration and constant degradation of formed clots [22].…”

Section: Discussionmentioning

confidence: 99%

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Role of the Clinical Pharmacist in Detection of Drug Therapy Problems in Critically Inpatients: Experience Report

Alves¹

2014

J Pharmacovigil

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This is an experience report on clinical pharmacy in New York, United States of America, in a teaching hospital, describing the results of drug therapy monitoring in critically ill patients, as well as interventions to solve or prevent identified drug therapy problems. The cross-sectional study was conducted by the clinical staff at the Surgical Intensive Care Unit during August 20th to 24th, 2012. Blood counts, serum levels of certain antibiotics, microbiological cultures and their antibiotic susceptibility, possible drug interactions, dosage of each drug prescribed and the compatibility between the route of administration and pharmaceutical form were assessed daily through review of electronic medical records. Twenty seven patients were followed up and 16 drug therapy problems were identified: Unnecessary drug therapy (seven), adverse drug reaction (four), needs additional drug therapy (two), noncompliance (two) and dosage too low (one). After evaluation, the drug therapy problems and their pharmaceutical interventions were reported to clinical pharmaceutical responsible for the Surgical ICU, as well as the multidisciplinary team. Further, the clinical outcomes were monitored and interventions were classified as to its acceptance. Data demonstrate that clinical pharmacists can contribute to the security and proper use of medications, as the trigger tools for intensive monitoring helps in early detection of drug therapy problems and patient safety.

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Histamine-2 Receptor Antagonists vs Proton Pump Inhibitors on Gastrointestinal Tract Hemorrhage and Infectious Complications in the Intensive Care Unit

2014

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IMPORTANCE Histamine-2 receptor antagonists (H 2 RAs) and proton pump inhibitors (PPIs) are commonly used to prevent gastrointestinal tract (GI) hemorrhage in critically ill patients. The stronger acid suppression of PPIs may reduce the rate of bleeding but enhance infectious complications, specifically pneumonia and Clostridium difficile infection (CDI). OBJECTIVE To evaluate the occurrence and risk factors for GI hemorrhage, pneumonia, and CDI in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS A pharmacoepidemiological cohort study was conducted of adult patients requiring mechanical ventilation for 24 hours or more and administered either an H 2 RA or PPI for 48 hours or more while intubated across 71 hospitals between January 1, 2003, and December 31, 2008. Propensity score-adjusted and propensity-matched multivariate regression models were used to control for confounders. MAIN OUTCOMES AND MEASURES Primary outcomes were secondary diagnoses of International Classification of Diseases, Ninth Revision (ICD-9)-coded GI hemorrhage, pneumonia, and CDI occurring 48 hours or more after initiating invasive ventilation. RESULTS Of 35 312 patients, 13 439 (38.1%) received H 2 RAs and 21 873 (61.9%) received PPIs. Gastrointestinal hemorrhage (2.1% vs 5.9%; P < .001), pneumonia (27% vs 38.6%; P < .001), and CDI (2.2% vs 3.8%; P < .001) occurred less frequently in the H 2 RA group. After adjusting for propensity score and covariates, odds ratios of GI hemorrhage (2.24; 95% CI, 1.81-2.76), pneumonia (1.2; 95% CI, 1.03-1.41), and CDI (1.29; 95% CI, 1.04-1.64) were greater with PPIs. Similar results were obtained in the propensity-matched models of 8799 patients in each cohort. CONCLUSIONS AND RELEVANCE Proton pump inhibitors are associated with greater risks of GI hemorrhage, pneumonia, and CDI than H 2 RAs in mechanically ventilated patients. Numerous other risk factors are apparent. These data warrant confirmation in comparative prospective studies.

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Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients

Abstract: Immediate-release omeprazole suspension is effective in preventing upper gastrointestinal bleeding and more effective than intravenous cimetidine in maintaining gastric pH of >4 in critically ill patients.

Cited by 134 publications

References 18 publications

Evidence on measures for the prevention of ventilator-associated pneumonia

Evidence on measures for the prevention of ventilator-associated pneumonia

Role of the Clinical Pharmacist in Detection of Drug Therapy Problems in Critically Inpatients: Experience Report

Histamine-2 Receptor Antagonists vs Proton Pump Inhibitors on Gastrointestinal Tract Hemorrhage and Infectious Complications in the Intensive Care Unit

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