Prediction of Ventilator-Associated Pneumonia in Patients Undergoing Stress Ulcer Prophylaxis: A Longitudinal Descriptive Study in Iran

Document Type : Original Article

Authors

1 Assistant Professor, Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Assistant Professor, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Assistant Professor, Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Skull Base Research Center, Loghman Hakim Hospital& Department of Health and Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran

Abstract

Background: The purpose of this study was to investigate and predict ventilator-associated pneumonia (VAP) in the two groups of patients who received either proton pump inhibitors (Pantoprazole) or histamine H2 antagonist (Ranitidine).
Methods: Patients in ICU received Pantoprazole or Ranitidine as stress-related mucosal injury and GI bleeding prophylaxis. The incidence rate of VAP and GI bleeding was estimated in each group during ICU stay. Chi-Square and Multivariate Logistic Regression Test were used for data analysis. P.value less than 0.05 was considered significant. Data analysis was performed through SPSS version 19.0.
Results: The incidence rate of VAP in the Ranitidine and Pantoprazole groups was 44.7% and 37.3% respectively (p=0.3). According to the multivariable logistic regression analysis, length of mechanical ventilation ≥ 4 days was a predictive factor for VAP only in the Pantoprazole group (OR: 1.8, 95% CI: 1.56-1.90, p=0.006). No relationship between GI bleeding incidence and stress ulcer prophylaxis was found (p=0.4). Kaplan-Meier curve showed no significant difference between the two groups of Ranitidine and Pantoprazole (p=0.4) in survival time according to the length of ICU stay.
Conclusion: According to the results, there was no difference between the two groups in terms of VAP, GI bleeding and stress ulcer. Due to the lower cost of Ranitidine, it may be a more appropriate choice for GI bleeding prophylaxis in ICU patients.

Keywords


Kasper D, Fauci A, Hauser S, Longo D, Jameson L, Loscalzo J. Harrison's Principles of Internal Medicine.19th ed. USA: McGraw-Hill; 2015.
Buendgens L, Koch A, Tacke F. prevention of stress-related ulcer bleeding at the ICU: Risks and benefits of stress ulcer prophylaxis. World J Crit Care Med 2016; 5(1):57-64.
Hajiesmaeili MR, Moghadam OM, Sedaghat A, Niakan M, Seifi S, Bashar FR, et al. Evaluation of ventilator-associated pneumonia according to stress related mucosal disease prophylaxis regimen in the intensive care unit. Archives of Anesthesiology and Critical Care 2015; 1(4):116-9.
Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acidsuppressive medication use and the risk for hospital-acquired pneumonia. JAMA 2009; 301(20):2120-8.
Gulmez SE, Holm A, Frederiksen H, Jensen TG, Pedersen C, Hallas J. Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based casecontrolstudy. Arch Intern Med 2007; 167(9):950-5.
Barkun AN, Bardou M, Pham CQ, Martel M. Proton Pump inhibitore vs histamine 2 receptor antagonists for stress-related mucosal bleeding prophylaxis in critically ill patients: a meta-analysis. Am J Gastroentro 2012; 107(4):507-20.
Grindlinger GA, Cairo SB, Duperre CB. Pneumonia prevention in intubated patients given sucralfate vs proton-pump inhibitors and/or histamine II receptor blockers. J Surg Res 2016; 206(2):398-404.
Hammond DA, Kathe N, Shah A, Martin BC. Cost-effectiveness of histamine 2 receptor antagonists versus proton pump inhibitors for stress ulcer prophylaxis in critically ill patients. Pharmacotherapy 2017; 37(1):43-53.
MacLaren R, Reynolds PM, Allen RR. Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit. JAMA Intern Med 2014; 174(4):564-74.
 
MacLaren R, Reynolds PM, Allen RR. Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit. JAMA Intern Med 2014; 174(4):564-74.
Buendgens L, Bruensing J, Matthes M, Dückers H, Luedde T, Trautwein C, et al. Administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile-associated diarrhea. J Crit Care 2014; 29(4):696.e11-5.
Rahimi Bashar F, Manuchehrian N, Mahmoudabadi M, Hajiesmaeili MR, Torabian S. Effects of ranitidine and pantoprazole on ventilator-associated pneumonia: a randomized double-blind clinical trial. Tanaffos 2013; 12(2):16-21.
STROBE Statement. STROBE checklist. [cited 2020 Jul 17] Available from: https://www.strobe-statement.org/index.php?id=available-checklists.
Zhou XY, Ben SQ, Chen HL, Ni SS. A comparison of APACHE II and CPIS scores for the prediction of 30-day mortality in patients with ventilator-associated pneumonia. International Journal of Infectious Diseases 2015; 30:144-7.
Smith MN, Erdman MJ, Ferreira JA, Aldridge P, Jankowski CA. Clinical utility of methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction assay in critically ill patients with nosocomial pneumonia. J Crit Care 2017; 38:168-71.
Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 2015; 162(1):W1-73.
Biswas A. Number needed to treat. Journal of the Practice of Cardiovascular Sciences 2017; 3(2):106.
Koletsi D, Pandis N. Survival analysis, part 2: Kaplan-Meier method and the log-rank test. Am J Orthod Dentofacial Orthop. 2017; 152(4):569-71.
Nateghinia S, Afshar Kazemi MA, Sepehri MM, Goharani R. Neurocritical care unit bed allocation: optimization based on prioritization using simulation. Archives of Neuroscience 2018; 5(3).
Rahimi Bashar F, Rastgouyhaghi A, Torabian S, Hajiesmaeili MR, Sedaghat A, Seifi S, et al. Prevention of stress related mucosal disease with intermittent intravenous pantoprazole and ranitidine in critically ill patients. J Pharm Care 2013; 1(3):81-8.
Alhazzani W, Alenezi F, Jaeschke RZ, Moayyedi P, Cook DJ. Proton pump inhibitors Versus Histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2013; 41(3):693-705.
Miano TA, Reichert MG, Houle TT, MacGregor DA, Kincaid EH, Bowton D. Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest 2009; 136(2):440-7.
Laheij RF, Sturkenboom MC, Hassing RJ, Dieleman J, Stricker BH, Jansen JB. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004; 292(16):1955-60.
Alshamsi F, Belley-Cote E, Cook D, Almenawer SA, Alqahtani Z, Perri D, et al. Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systemic review and meta-analysis of randomized trials. CritbCare 2016; 20(1):120.
Lin PC, Chang CH, Hsu PI, Tseng PL, Huang YB. The efficacy and safety of proton pump inhibitor vs. histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: a meta-analysis. Crit Care Med; 38(4):1197-205.
Khorvash F, Abbasi S, Meidani M, Dehdashti F, Ataei B. The comparison between proton pump inhibitor and sucralfate in incidence of ventilator associated pneumonia in critically ill patients. Adv Biomed Res 2014; 3:52.
Alhazzani W, Guyatt G, Alshahrani M, Deane AM, Marshall JC, Hall R, et al. Withholding pantoprazole for stress ulcer prophylaxis in critically ill patients: a pilot randomized clinical trial and meta-analysis. Crit Care Med 2017; 45(7):1121-9.
Offenstadt G, Maury E. Upper gastrointestinal bleeding in severe sepsis. Critical Care Medicine 2008; 36(6):1990-1.
Charles MV, Easow JM, Joseph NM, Ravishankar M, Kumar S, Umadevi S. Incidence and risk factors of ventilator associated pneuomonia in tertiary care hospital. Australas Med J 2013; 6(4):178-82.