Abstract

STRESS ULCER PROPHYLAXIS IN ICU PATIENTS

Camila A. Carlman and Dr. Jeethu Joby*

Abstract

Proton Pump Inhibitors (PPIs) are class of medications that work on the cell that line the stomach, reducing the production of acid. Histamine-2 receptor antagonists are having similar effects as that of PPIs but different mode of action. H2-receptor blockers (H2RBs) are class of medication that block the action of histamine at the histamine H2 receptor of the parietal cells in the stomach and decreases acid secretion. The use of PPIs and H2-Receptor Blockers for the prevention of stress ulcer has been well defined in ICU patients. To compare the effect of both these drugs on hospital mortality, several crossover randomization studies was conducted. Patients receiving invasive mechanical ventilation within 24 hours of index hospitalisation were followed up for 90 days with 6 months preferential use of PPIs vs. H2- RBs, followed by 6 month alternative therapy. Studies suggest that the primary outcome was mortality within 90 days & secondary outcome was the rates of patients with Upper Gastrointestinal Bleeding (UGIB) and Clostridioides difficile infection. As per the data, the mortality rates were high among patients receiving PPIs than H2-RBs and the absolute risk difference was about 0.93%. UGIB occurred more in PPIs group while comparing to H2-RBs group. Rates of Clostridioides difficile and ICU length of stay were not different by treatment group. Post hoc analysis revealed that patient at higher risk strata had greater mortality after assignment to PPIs compared to H-2RBs. The PPIs vs. H-2RBs for stress ulcer prophylaxis had higher 90 day mortality that did not reach significant threshold.

Keywords: Proton Pump Inhibitors, Histamine-2 receptor blocker, ICU patients, Stress ulcer prophylaxis.