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H2 blockers trump ppi for prophylaxis in vented patients

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By Jason Mann No BS pulmonary critical care fellow
https://www.readbyqxmd.com/read/24535015/histamine-2-receptor-antagonists-vs-proton-pump-inhibitors-on-gastrointestinal-tract-hemorrhage-and-infectious-complications-in-the-intensive-care-unit
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COMPARATIVE STUDY
Robert MacLaren, Paul M Reynolds, Richard R Allen
IMPORTANCE Histamine-2 receptor antagonists (H2RAs) 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 H2RA or PPI for 48 hours or more while intubated across 71 hospitals between January 1, 2003, and December 31, 2008...
April 2014: JAMA Internal Medicine
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