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PPI in intensive care

Madhusudana Pulaganti, Anuradha C M, Chitta Suresh Kumar
Pseudomonas aeruginosa (P.aeruginosa) is an opportunistic microorganism causing diseases both in animals and humans. In case of human pathology, the role of P.aeruginosa is one of the major concerns in intensive care septicemia. Presently the drug resistance strains of P.aeruginosa are arising mainly by developing multiple mechanisms due to its natural and acquired resistance to many of the antimicrobial agents commonly used in clinical practice. As a result, there is a direneed to invent new drugs so that they may restrict the outbreak of multidrug resistant strains...
August 15, 2016: Journal of Biomolecular Structure & Dynamics
David M Faleck, Hojjat Salmasian, E Yoko Furuya, Elaine L Larson, Julian A Abrams, Daniel E Freedberg
OBJECTIVES: Patients in the intensive care unit (ICU) frequently receive proton pump inhibitors (PPIs) and have high rates of Clostridium difficile infection (CDI). PPIs have been associated with CDI in hospitalized patients, but ICU patients differ fundamentally from non-ICU patients and few studies have focused on PPI use exclusively in the critical care setting. We performed a retrospective cohort study to determine the associations between PPIs and health-care facility-onset CDI in the ICU...
August 30, 2016: American Journal of Gastroenterology
Mahboubeh Valiani, Mehri Rezaie, Zahra Shahshahan
BACKGROUND: Labor is a physiologic process, and consideration of labor pain and relieving that is among the major components of maternal care. Application of some labor position can lay the fetus better in pelvic canal direction. The present study aimed to investigate the effect of laying the mother in three labor positions on the pain severity in the second, third, and fourth stages of labor. MATERIALS AND METHODS: This is a clinical trial conducted on 96 primiparous pregnant women randomly selected through convenient sampling from those who were hospitalized in the hospitals of Isfahan and Jahrom...
July 2016: Iranian Journal of Nursing and Midwifery Research
Jessica Michal, Thomas Henry, Connie Street
PURPOSE: Results of a pharmacist-driven protocol to decrease proton pump inhibitor (PPI) use in non-intensive care unit (ICU) hospitalized adults are presented. METHODS: This concurrent preintervention and postintervention study included subjects at least 18 years of age receiving PPIs while hospitalized in general medical or surgical beds. Patients were identified for inclusion in the postintervention group using a daily list of hospitalized patients with active PPI orders...
September 1, 2016: American Journal of Health-system Pharmacy: AJHP
Philip Wai Yan Chiu, Henry Kin Ming Joeng, Catherine Lai Yin Choi, Kelvin Kam Fai Tsoi, Kwok Hung Kwong, Siu Ho Lam, Joseph Jao Yiu Sung
BACKGROUND AND STUDY AIM: Previous studies have shown that both scheduled second-look endoscopy and high-dose continuous omeprazole infusion are effective in preventing peptic ulcer rebleeding. The aim of this noninferiority trial was to compare the efficacy of these two strategies for the prevention of rebleeding following primary endoscopic hemostasis. PATIENTS AND METHODS: Consecutive patients who received endoscopic treatment for bleeding peptic ulcers (actively bleeding, with nonbleeding visible vessels) were randomized to two treatment groups following hemostasis...
August 2016: Endoscopy
Jonathan L Slaughter, Michael R Stenger, Patricia B Reagan, Sudarshan R Jadcherla
OBJECTIVE: To determine treatment frequency and duration of histamine-2 receptor antagonist (H2RA)/proton pump inhibitor (PPI) use among infants hospitalized within US children's hospital neonatal intensive care units and evaluate diagnoses/demographic factors associated with use. STUDY DESIGN: We retrospectively analyzed a cohort of neonatal intensive care unit infants admitted to 43 US children's hospitals within the Pediatric Health Information System database between January 2006 and March 2013 to determine H2RA/PPI treatment frequency, timing/duration of treatment, factors associated with use, percent of infants remaining on treatment at discharge, and interhospital prescribing variation...
July 2016: Journal of Pediatrics
R Singh, R Trickett, Cer Meyer, S Lewthwaite, D Ford
Introduction Acute gastrointestinal stress ulceration is a common and serious complication of trauma. Prophylactic proton pump inhibitors (PPIs) or histamine receptor antagonists have been used in poly-trauma, burns and head and spinal injuries, as well as on intensive care units, for the prevention of acute gastric stress ulcers. Methods We prospectively studied the use of prophylactic PPIs in with femoral neck fracture patients, gathering data on all acute gastric ulcer complications, including coffee-ground vomiting, malena and haematemesis...
July 2016: Annals of the Royal College of Surgeons of England
Youngouk Ro, Chang Soo Eun, Hyun Soo Kim, Ji Yeoun Kim, Young Jae Byun, Kyo-Sang Yoo, Dong Soo Han
BACKGROUND/AIMS: Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly prescribed for stress ulcer prophylaxis (SUP) in critically ill patients. Several studies have suggested that the use of PPIs is a potential risk factor for Clostridium difficile infection (CDI). We compared the incidences of CDI in the PPI group and H2RA group for SUP in critically ill patients. METHODS: From August 2005 to July 2012, the incidences of CDI were retrospectively analyzed in patients who were admitted directly to intensive care units and stayed for more than 3 days...
July 15, 2016: Gut and Liver
Melissa Shears, Waleed Alhazzani, John C Marshall, John Muscedere, Richard Hall, Shane W English, Peter M Dodek, François Lauzier, Salmaan Kanji, Mark Duffett, Jeffrey Barletta, Mohammed Alshahrani, Yaseen Arabi, Adam Deane, Deborah J Cook
PURPOSE: Stress ulcer prophylaxis (SUP) using histamine-2-receptor antagonists has been a standard of care in intensive care units (ICUs) for four decades. Proton pump inhibitors (PPIs) are increasingly used despite apparently lower background rates of gastrointestinal bleeding and growing concerns about PPI-associated complications. Our objective was to understand the views and prescribing habits amongst Canadian physicians regarding SUP in the ICU and to gauge interest in a future randomized-controlled trial (RCT)...
June 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Lukas Buendgens, Alexander Koch, Frank Tacke
Stress-related mucosal disease is a typical complication of critically ill patients in the intensive care unit (ICU). It poses a risk of clinically relevant upper gastrointestinal (GI) bleeding. Therefore, stress ulcer prophylaxis (SUP) is recommended in high-risk patients, especially those mechanically ventilated > 48 h and those with a manifest coagulopathy. Proton pump inhibitors (PPI) and, less effectively, histamine 2 receptor antagonists (H2RA) prevent GI bleeding in critically ill patients in the ICU...
February 4, 2016: World Journal of Critical Care Medicine
Matt Pappas, Sanjay Jolly, Sandeep Vijan
BACKGROUND: Proton-pump inhibitors (PPIs) are commonly used among medical inpatients, both for prophylaxis against upper gastrointestinal bleeding (UGIB) and continuation of outpatient use. While PPIs reduce the risk of UGIB, they also appear to increase the risk of hospital-acquired pneumonia (HAP) and Clostridium difficile infection (CDI). Depending upon the underlying risks of these conditions and the changes in those risks with PPIs, use of proton-pump inhibitors may lead to a net benefit or net harm among medical inpatients...
April 2016: Journal of General Internal Medicine
Maja Ogielska, Philippe Lanotte, Cécile Le Brun, Anne Sophie Valentin, Denis Garot, Anne-Charlotte Tellier, Jean Michel Halimi, Philippe Colombat, Laurent Guilleminault, Bertrand Lioger, Hélène Vegas, Bertrand De Toffol, Thierry Constans, Louis Bernard
BACKGROUND: Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhoea. People in the general community are not usually considered to be at risk of CDI. CDI is associated with a high risk of morbidity and mortality. The risk of severity is defined by the Clostridium Severity Index (CSI). METHODS: The cases of 136 adult patients with CDI treated at the University Hospital of Tours, France between 2008 and 2012 are described. This was a retrospective study...
August 2015: International Journal of Infectious Diseases: IJID
Abdullah AlBedah, Mohamed Khalil, Ahmed Elolemy, Asim A Hussein, Meshari AlQaed, Abdullah Al Mudaiheem, Raid A Abutalib, Faisal Mohamed Bazaid, Ahmad Saeed Bafail, AboBakr Essa, Mohammed Yahia Bakrain
OBJECTIVES: To evaluate the effectiveness and safety of wet cupping therapy as a single treatment for persistent nonspecific low back pain (PNSLBP). DESIGN: Randomized controlled trial comparing wet cupping versus no treatment in PNSLBP. SETTING: Outpatient clinic in three secondary care hospitals in Saudi Arabia. PATIENTS: Eighty eligible participants with PNSLBP for at least 3 months were randomly allocated to an intervention group (n=40) or to a control group (n=40)...
August 2015: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
Sooyoung Shin
BACKGROUND: Stress ulcers and related upper gastrointestinal bleeding are well-known complications in intensive care unit (ICU) patients. Proton pump inhibitor (PPI)-based stress ulcer prophylaxis (SUP) has been widely prescribed in noncritically ill patients who are at low risk for clinically significant bleeding, which is then injudiciously continued after hospital discharge. This study aimed to evaluate the incidence of inappropriate prescribing of PPI-based preventative therapy in ICU versus non-ICU patients that subsequently continued postdischarge, and to estimate the costs incurred by the unwarranted outpatient continuation of PPI therapy...
2015: Therapeutics and Clinical Risk Management
Bob Geng, Ami Thakor, Elisabeth Clayton, Lindsay Finkas, Marc A Riedl
BACKGROUND: Identification of factors adversely affecting the utility of allergy skin testing is important in optimizing patient care. Inpatient penicillin skin test data from 1997 through 2007 demonstrate that up to 20% of attempted penicillin skin tests are indeterminate owing to a negative histamine test response, despite exclusion of H1 antagonists. Critical illness, vasopressors, steroid use, and psychotropic medications have been postulated to influence outcomes, but large studies are lacking...
July 2015: Annals of Allergy, Asthma & Immunology
Andrew T Costarino, Dingwei Dai, Rui Feng, Chris Feudtner, James P Guevara
OBJECTIVES: Stress-related gastrointestinal bleeding may occur in PICU patients. Raising gastric pH with acid suppressant medications is the accepted treatment. We describe the use of histamine 2 receptor blockers and proton pump inhibitors and associated factors among a national sample of PICU patients. DESIGN: Retrospective cohort analysis using Pediatric Health Information System clinically detailed administrative database. SETTING: Forty-two children's hospitals throughout the United States...
September 2015: Pediatric Critical Care Medicine
M Krag, A Perner, J Wetterslev, M P Wise, M Borthwick, S Bendel, C McArthur, D Cook, N Nielsen, P Pelosi, F Keus, A B Guttormsen, A D Moller, M H Møller
BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries. METHODS: Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects...
May 2015: Acta Anaesthesiologica Scandinavica
Mette Krag, Anders Perner, Jørn Wetterslev, Matt P Wise, Mark Borthwick, Stepani Bendel, Colin McArthur, Deborah Cook, Niklas Nielsen, Paolo Pelosi, Frederik Keus, Anne Berit Guttormsen, Alma D Moller, Morten Hylander Møller
PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU) during a 7-day period. The primary outcome was clinically important GI bleeding in ICU, and the analyses included estimations of baseline risk factors and potential associations with 90-day mortality...
May 2015: Intensive Care Medicine
Yasamin Dabiri, Fanak Fahimi, Hamidreza Jamaati, Seyed Mohammad Reza Hashemian
BACKGROUND: Stress-related mucosal disease occurs in many critically ill-patients within 24 h of admission. Proton pump inhibitor therapy has been documented to produce more potent inhibition of gastric acid secretion than histamine 2 receptor antagonists. This study aimed to compare extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous (IV) pantoprazole on the gastric pH in intensive care unit patients. MATERIALS AND METHODS: This was a randomized single-blind-study...
January 2015: Indian Journal of Critical Care Medicine
Susan Owensby, Kellee Taylor, Thad Wilkins
Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit...
January 2015: Journal of the American Board of Family Medicine: JABFM
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