Investigating and Comparing the Severity and Prevalence of Ventilator-Induced Pneumonia in Patients Taking Famotidine and Pantoprazole in the Intensive Care Unit: A Clinical Trial
Abstract
Background: Patients admitted to the intensive care unit (ICU) are at high risk of gastrointestinal (GI) mucosal injury and stress ulcers, which may lead to gastrointestinal bleeding, due to their critical condition and use of mechanical ventilation. Stress ulcer prophylaxis drug regimens, including proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs), are commonly used to prevent these complications. However, there are concerns about the side effects of these drugs, including an increased risk of ventilator-associated pneumonia (VAP). This study aimed to compare the effects of pantoprazole and famotidine on clinical outcomes and the risk of VAP in patients admitted to the ICU.
Methods: This study was designed as a single-center randomized clinical trial conducted in the Intensive Care Unit (ICU). The study population included 138 patients admitted to the ICU who required mechanical ventilation. The treatment regimens studied included two groups: group 1 received intravenous pantoprazole (40 mg daily), and group 2 received intravenous famotidine (20 mg twice daily). The study's primary outcome measure was the incidence of VAP, which was assessed according to ATS/IDSA and CDC guidelines. Other clinical variables included ICU length of stay, APACHE score, and incidence of adverse events.
Results: The results showed that in the famotidine group, ICU length of stay and APACHE II score were significantly shorter than in the pantoprazole group. However, no statistically significant differences were observed in variables such as age, weight, drug administration duration, and intubation duration. In addition, the frequency of death and pneumonia incidence in the famotidine group was lower than in the pantoprazole group, although this difference was not statistically significant.
Conclusion: This study showed that both famotidine and pantoprazole are effective in the prophylaxis of stress ulcers in critically ill ICU patients, but famotidine may be associated with more favorable clinical outcomes, including reduced length of stay and severity of illness. Also, the use of gastric acid suppressant drugs is associated with an increased risk of VAP, which requires more attention to drug selection and patient management. The findings of this study can help in better decision-making regarding the use of SUP drugs in ICU patients.
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[4] Klompas M. Prevention of intensive care unit-acquired pneumonia. Semin Respir Crit Care Med. 2019;40(4):548–57.
[5] Anderson BJ, Reilly JP, Shashaty MG, Palakshappa JA, Wysoczanski A, Dunn TG, et al. Admission plasma levels of the neuronal injury marker neuron-specific enolase are associated with mortality and delirium in sepsis. J Crit Care. 2016;36:18–23.
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[8] Saeed M, Bihorac A, Chaisson NF. Which ICU patients need stress ulcer prophylaxis? Cleve Clin J Med. 2022;89(7):363–7.
[9] Cook D, Daneman N, Lauzier F, Zytaruk N, Guyatt G, Saunders L, et al. Stress ulcer prophylaxis during invasive mechanical ventilation. N Engl J Med. 2024;391(1):9–20.
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[11] Rea-Neto A, Youssef NC, Tuche F, Brunkhorst F, Ranieri VM, Reinhart K, et al. Diagnosis of ventilator-associated pneumonia: a systematic review of the literature. Crit Care. 2008;12(2):R56.
[12] Fàbregas N, Ewig S, Torres A, El-Ebiary M, Ramirez J, de La Bellacasa JP, et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax. 1999;54(10):867–73.
[13] Wunderink RG, Woldenberg LS, Zeiss J, Day CM, Ciemins J, Lacher DA. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest. 1992;101(2):458–63.
[14] Krag M, Marker S, Perner A, Wetterslev J, Wise MP, Schefold JC, et al. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. N Engl J Med. 2018;379(23):2199–208.
[15] Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991; 143(5_pt_1):1121-9.
[16] Fartoukh M, Maitre B, Honoré S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med. 2003 Jul 15;168(2):173–9.
[17] Bonten MJ, Gaillard CA, de Leeuw PW, Stobberingh EE. Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia. Clin Infect Dis. 1997;24(3):309–19.
[18] Li HY, He L, Hu BJ, Wang BQ, Zhang XY, Chen XH, Dong L. [The impact of gastric colonization on the pathogenesis of ventilator-associated pneumonia]. Zhonghua Nei Ke Za Zhi. 2004;43(2):112–6. Chinese.
[19] Ma J, He L, Bao H. [Gastric colonization and its effect on pathogenesis of nosocomial pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 1999;22(2):104–7. Chinese.
[20] Bonten MJ, Bergmans DC, Ambergen AW, de Leeuw PW, van der Geest S, Stobberingh EE, Gaillard CA. Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients. Am J Respir Crit Care Med. 1996;154(5):1339–46.
[21] Messori A, Trippoli S, Vaiani M, Gorini M, Corrado A. Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ. 2000;321:1103.
[22] Pongprasobchai S, Kridkratoke S, Nopmaneejumruslers C. Proton pump inhibitors for the prevention of stress-related mucosal disease in critically ill patients: a meta-analysis. J Med Assoc Thai. 2009;92(5):632–7.
[23] Pozuelo-Carrascosa DP, Cavero-Carbonell C, Carmona-Torres JM, Laredo-Aguilera JA, Santacruz-Salas E, Fernandez-Rodriguez R. Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis. J Intensive Care. 2022;10(1):9.
[24] 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.
[25] Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;46(5):888–906.
[26] Song MJ, Kim S, Boo D, Park C, Yoo S, Yoon HI, et al. Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit. Sci Rep. 2021;11(1):18467.
[27] 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.
[28] Fogas J, Kettős K, Gyura F, Tobias Z, Molnar Z. Effects of proton pump inhibitor versus H2-receptor antagonist stress ulcer prophylaxis on ventilator-associated pneumonia: a pilot study. Crit Care. 2013;17(Suppl 2):P200.
[29] Selvanderan SP, Smith M, Finnis ME, et al. Pantoprazole or placebo for stress ulcer prophylaxis (POP-UP). Crit Care Med. 2016;44(9):1842–50.
[30] American Thoracic Society, Infectious Diseases Society of America, and the Guidelines for the Management of Ventilator-Associated Pneumonia. Am J Respir Crit Care Med. 2005;171(4):388.
[31] New Zealand Intensive Care Society Clinical Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group, et al. Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital mortality among ICU patients receiving invasive mechanical ventilation: The PEPTIC Randomized Clinical Trial. JAMA. 2020;323(7):616–26.
[32] Bashar FR, 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.
[33] Arai N, Nakamura A, Tabuse M, et al. Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients. PLoS One. 2017;12(1):e0169300.
[34] Banna S, Schenck C, Shahu A, et al. Stress Ulcer Prophylaxis in Mechanically Ventilated Patients With Acute Myocardial Infarction. JACC Adv. 2024;3(1):100750.
[35] Bardou M, Quenot JP, Barkun A. Stress-related mucosal disease in the critically ill patient. Nat Rev Gastroenterol Hepatol. 2015; 12(2):98-107.
[36] Li F, Liu H, Zhang L, Huang X, Liu Y, Li B, et al. Effects of Gastric Acid Secretion Inhibitors for Ventilator-Associated Pneumonia. Front Pharmacol. 2022;13:898422.
[37] Miano TA, Reynolds RM, Houle TT, MacGregor DA, Kincaid EH, Bowton DL. Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest. 2009;136(2):440–7.
[38] Apte NM, Kachole D, Medhekar TP, Tilve GH, Morye S, Bhave GG. Gastric colonization and pneumonia in intubated critically ill patients receiving stress ulcer prophylaxis: a randomized controlled trial. Crit Care Med. 1992;20(5):590–3.
[39] Lin PC, Chen CY, Hsu PI, Tseng PL, Huang YB. The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: a meta-analysis. Crit Care Med. 2010;38(4):1197–205.
[40] Kantorova I, Sumbera P, Scheer P, Doubek J, Rehorkova D, Bosakova H, et al. Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology. 2004;51(57):757–61.
[41] Alshamsi F, Bhat-Charumilind V, 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 systematic review and meta-analysis of randomized trials. Crit Care. 2016;20(1):120.
[42] Wu LH, Wang JL, Liu YH, Su CC, Yang YK, Lin SJ, et al. Hospitalized patients on proton pump inhibitors for stress ulcer prophylaxis have a higher risk of Clostridioides difficile infection compared with those on histamine-2 receptor antagonists. J Hosp Infect. 2024;154:9–17.
[43] Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002; 165(7):867-903.
[44] Blot S, Koulenti D, Dimopoulos G, Martin C, Komnos A, Krueger WA, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med. 2014;42(3):601–9.
[45] Li W, Chen J, Ding L, Wang X, Xu H. Incidence and risk factors of ventilator-associated pneumonia in the intensive care unit: a systematic review and meta-analysis. J Thorac Dis. 2024;16(9):5518–28.
[46] Weinstein RA, Marin H, Kollef M, Hall JB. Risk Factors for Ventilator-Associated Pneumonia: From Epidemiology to Patient Management. Clin Infect Dis. 2004; 38(8):1141–9.
[47] Addington WR, Stenhouse SA, Gilliland KA. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. Stroke. 1999;30(6):1203–7.
[48] Li Y, Liu C, Xiao W, Song T, Wang S. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis. Neurocrit Care. 2020;32(1):272–85.
[49] Patel P, Gandhi S, Patel H, Bashar MDA. Assessment of APACHE II Score to Predict ICU Outcomes of Patients with AKI: A Single-center Experience from Haryana, North India. Indian J Crit Care Med. 2022;26(3):276–81.
[50] Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med. 1985; 13(10):818–29.
[51] Ng FH, Tong PK, Chu WM, Lam KF, Li A, Chan K, et al. Esomeprazole compared with famotidine in the prevention of upper gastrointestinal bleeding in patients with acute coronary syndrome or myocardial infarction. Am J Gastroenterol. 2012;107(3):389–96.
[52] Eom CS, Jeon JY, Lim JW, Cho EG, Park SM, Lee KS. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ. 2011; 183(3):310–9.
[53] Barkun AN, Martel M, Pham CQ. Proton pump inhibitors vs. histamine 2 receptor antagonists for stress-related mucosal bleeding prophylaxis in critically ill patients: a meta-analysis. Am J Gastroenterol. 2012;107(4):507–20.
[54] Whitman CP, Jasmine A, Patel B, Vito K, Gerber D. Ventilator-associated pneumonia risk between proton pump inhibitors and histamine antagonists. Crit Care Med. 2013;41(12):A221.
[55] Mohd Sazlly Lim S, ZAA, Liew SM, Roberts JA, Sime FB. The global prevalence of multidrug resistance among Acinetobacter baumannii causing hospital-acquired and ventilator-associated pneumonia and its associated mortality: A systematic review and meta-analysis. J Infect. 2019;79(6):593–600.
[56] Ben Lakhal H, MRA, Naas T, Brahmi N. Antimicrobial susceptibility among pathogens isolated in early-onset versus late-onset ventilator-associated pneumonia. Infect Dis Rep. 2021; 13(2):401–10.
[57] Restrepo MI, Passi P, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care. 2013; 58(7):1220–5.
[58] Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, et al. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun. 2024; 15:6447.
[59] Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016; 63(5):e61–e111.
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[61] Ojiako K, Schorr C, Gerber DR. Famotidine versus pantoprazole for preventing bleeding in the upper gastrointestinal tract of critically ill patients receiving mechanical ventilation. Am J Crit Care. 2008;17(2):142–7.
[2] Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995;274(8):639–44.
[3] Cook D. Ventilator associated pneumonia: perspectives on the burden of illness. Intensive Care Med. 2000; 26:S031-7.
[4] Klompas M. Prevention of intensive care unit-acquired pneumonia. Semin Respir Crit Care Med. 2019;40(4):548–57.
[5] Anderson BJ, Reilly JP, Shashaty MG, Palakshappa JA, Wysoczanski A, Dunn TG, et al. Admission plasma levels of the neuronal injury marker neuron-specific enolase are associated with mortality and delirium in sepsis. J Crit Care. 2016;36:18–23.
[6] Barbateskovic M, Marker S, Granholm A, Anthon CT, Krag M, Jakobsen JC, et al. Stress ulcer prophylaxis with proton pump inhibitors or histamine-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Med. 2019;45:143–58.
[7] Alhujilan SS, Subaiee SA, Alalwan AA. Assessment of adherence to the national stress ulcer prophylaxis guidelines: A cross-sectional analysis. Saudi Pharm J. 2023;31(10):101754.
[8] Saeed M, Bihorac A, Chaisson NF. Which ICU patients need stress ulcer prophylaxis? Cleve Clin J Med. 2022;89(7):363–7.
[9] Cook D, Daneman N, Lauzier F, Zytaruk N, Guyatt G, Saunders L, et al. Stress ulcer prophylaxis during invasive mechanical ventilation. N Engl J Med. 2024;391(1):9–20.
[10] Krag M, Perner A, Wetterslev J, Wise MP, Borthwick M, Bendel S, et al. Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries. Acta Anaesthesiol Scand. 2015;59(5):576–85.
[11] Rea-Neto A, Youssef NC, Tuche F, Brunkhorst F, Ranieri VM, Reinhart K, et al. Diagnosis of ventilator-associated pneumonia: a systematic review of the literature. Crit Care. 2008;12(2):R56.
[12] Fàbregas N, Ewig S, Torres A, El-Ebiary M, Ramirez J, de La Bellacasa JP, et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax. 1999;54(10):867–73.
[13] Wunderink RG, Woldenberg LS, Zeiss J, Day CM, Ciemins J, Lacher DA. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest. 1992;101(2):458–63.
[14] Krag M, Marker S, Perner A, Wetterslev J, Wise MP, Schefold JC, et al. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. N Engl J Med. 2018;379(23):2199–208.
[15] Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991; 143(5_pt_1):1121-9.
[16] Fartoukh M, Maitre B, Honoré S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med. 2003 Jul 15;168(2):173–9.
[17] Bonten MJ, Gaillard CA, de Leeuw PW, Stobberingh EE. Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia. Clin Infect Dis. 1997;24(3):309–19.
[18] Li HY, He L, Hu BJ, Wang BQ, Zhang XY, Chen XH, Dong L. [The impact of gastric colonization on the pathogenesis of ventilator-associated pneumonia]. Zhonghua Nei Ke Za Zhi. 2004;43(2):112–6. Chinese.
[19] Ma J, He L, Bao H. [Gastric colonization and its effect on pathogenesis of nosocomial pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 1999;22(2):104–7. Chinese.
[20] Bonten MJ, Bergmans DC, Ambergen AW, de Leeuw PW, van der Geest S, Stobberingh EE, Gaillard CA. Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients. Am J Respir Crit Care Med. 1996;154(5):1339–46.
[21] Messori A, Trippoli S, Vaiani M, Gorini M, Corrado A. Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ. 2000;321:1103.
[22] Pongprasobchai S, Kridkratoke S, Nopmaneejumruslers C. Proton pump inhibitors for the prevention of stress-related mucosal disease in critically ill patients: a meta-analysis. J Med Assoc Thai. 2009;92(5):632–7.
[23] Pozuelo-Carrascosa DP, Cavero-Carbonell C, Carmona-Torres JM, Laredo-Aguilera JA, Santacruz-Salas E, Fernandez-Rodriguez R. Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis. J Intensive Care. 2022;10(1):9.
[24] 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.
[25] Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;46(5):888–906.
[26] Song MJ, Kim S, Boo D, Park C, Yoo S, Yoon HI, et al. Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit. Sci Rep. 2021;11(1):18467.
[27] 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.
[28] Fogas J, Kettős K, Gyura F, Tobias Z, Molnar Z. Effects of proton pump inhibitor versus H2-receptor antagonist stress ulcer prophylaxis on ventilator-associated pneumonia: a pilot study. Crit Care. 2013;17(Suppl 2):P200.
[29] Selvanderan SP, Smith M, Finnis ME, et al. Pantoprazole or placebo for stress ulcer prophylaxis (POP-UP). Crit Care Med. 2016;44(9):1842–50.
[30] American Thoracic Society, Infectious Diseases Society of America, and the Guidelines for the Management of Ventilator-Associated Pneumonia. Am J Respir Crit Care Med. 2005;171(4):388.
[31] New Zealand Intensive Care Society Clinical Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group, et al. Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital mortality among ICU patients receiving invasive mechanical ventilation: The PEPTIC Randomized Clinical Trial. JAMA. 2020;323(7):616–26.
[32] Bashar FR, 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.
[33] Arai N, Nakamura A, Tabuse M, et al. Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients. PLoS One. 2017;12(1):e0169300.
[34] Banna S, Schenck C, Shahu A, et al. Stress Ulcer Prophylaxis in Mechanically Ventilated Patients With Acute Myocardial Infarction. JACC Adv. 2024;3(1):100750.
[35] Bardou M, Quenot JP, Barkun A. Stress-related mucosal disease in the critically ill patient. Nat Rev Gastroenterol Hepatol. 2015; 12(2):98-107.
[36] Li F, Liu H, Zhang L, Huang X, Liu Y, Li B, et al. Effects of Gastric Acid Secretion Inhibitors for Ventilator-Associated Pneumonia. Front Pharmacol. 2022;13:898422.
[37] Miano TA, Reynolds RM, Houle TT, MacGregor DA, Kincaid EH, Bowton DL. Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest. 2009;136(2):440–7.
[38] Apte NM, Kachole D, Medhekar TP, Tilve GH, Morye S, Bhave GG. Gastric colonization and pneumonia in intubated critically ill patients receiving stress ulcer prophylaxis: a randomized controlled trial. Crit Care Med. 1992;20(5):590–3.
[39] Lin PC, Chen CY, Hsu PI, Tseng PL, Huang YB. The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: a meta-analysis. Crit Care Med. 2010;38(4):1197–205.
[40] Kantorova I, Sumbera P, Scheer P, Doubek J, Rehorkova D, Bosakova H, et al. Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology. 2004;51(57):757–61.
[41] Alshamsi F, Bhat-Charumilind V, 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 systematic review and meta-analysis of randomized trials. Crit Care. 2016;20(1):120.
[42] Wu LH, Wang JL, Liu YH, Su CC, Yang YK, Lin SJ, et al. Hospitalized patients on proton pump inhibitors for stress ulcer prophylaxis have a higher risk of Clostridioides difficile infection compared with those on histamine-2 receptor antagonists. J Hosp Infect. 2024;154:9–17.
[43] Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002; 165(7):867-903.
[44] Blot S, Koulenti D, Dimopoulos G, Martin C, Komnos A, Krueger WA, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med. 2014;42(3):601–9.
[45] Li W, Chen J, Ding L, Wang X, Xu H. Incidence and risk factors of ventilator-associated pneumonia in the intensive care unit: a systematic review and meta-analysis. J Thorac Dis. 2024;16(9):5518–28.
[46] Weinstein RA, Marin H, Kollef M, Hall JB. Risk Factors for Ventilator-Associated Pneumonia: From Epidemiology to Patient Management. Clin Infect Dis. 2004; 38(8):1141–9.
[47] Addington WR, Stenhouse SA, Gilliland KA. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. Stroke. 1999;30(6):1203–7.
[48] Li Y, Liu C, Xiao W, Song T, Wang S. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis. Neurocrit Care. 2020;32(1):272–85.
[49] Patel P, Gandhi S, Patel H, Bashar MDA. Assessment of APACHE II Score to Predict ICU Outcomes of Patients with AKI: A Single-center Experience from Haryana, North India. Indian J Crit Care Med. 2022;26(3):276–81.
[50] Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med. 1985; 13(10):818–29.
[51] Ng FH, Tong PK, Chu WM, Lam KF, Li A, Chan K, et al. Esomeprazole compared with famotidine in the prevention of upper gastrointestinal bleeding in patients with acute coronary syndrome or myocardial infarction. Am J Gastroenterol. 2012;107(3):389–96.
[52] Eom CS, Jeon JY, Lim JW, Cho EG, Park SM, Lee KS. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ. 2011; 183(3):310–9.
[53] Barkun AN, Martel M, Pham CQ. Proton pump inhibitors vs. histamine 2 receptor antagonists for stress-related mucosal bleeding prophylaxis in critically ill patients: a meta-analysis. Am J Gastroenterol. 2012;107(4):507–20.
[54] Whitman CP, Jasmine A, Patel B, Vito K, Gerber D. Ventilator-associated pneumonia risk between proton pump inhibitors and histamine antagonists. Crit Care Med. 2013;41(12):A221.
[55] Mohd Sazlly Lim S, ZAA, Liew SM, Roberts JA, Sime FB. The global prevalence of multidrug resistance among Acinetobacter baumannii causing hospital-acquired and ventilator-associated pneumonia and its associated mortality: A systematic review and meta-analysis. J Infect. 2019;79(6):593–600.
[56] Ben Lakhal H, MRA, Naas T, Brahmi N. Antimicrobial susceptibility among pathogens isolated in early-onset versus late-onset ventilator-associated pneumonia. Infect Dis Rep. 2021; 13(2):401–10.
[57] Restrepo MI, Passi P, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care. 2013; 58(7):1220–5.
[58] Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, et al. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun. 2024; 15:6447.
[59] Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016; 63(5):e61–e111.
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| Section | Research Article(s) | |
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| Ventilator-associated pneumonia Pantoprazole Famotidine stress ulcer prophylaxis intensive care unit | ||
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How to Cite
1.
Omidi S, ShiehMorteza M, Ghanbarzamani A. Investigating and Comparing the Severity and Prevalence of Ventilator-Induced Pneumonia in Patients Taking Famotidine and Pantoprazole in the Intensive Care Unit: A Clinical Trial. Arch Anesth & Crit Care. 2025;.
