Evaluation of Ventilator-Associated Pneumonia According to Stress Related Mucosal Disease Prophylaxis Regimen in the Intensive Care Unit

Abstract

Background: Ventilator-associated pneumonia (VAP) increases the cost of intensive care unit (ICU) treatment and the chance of mortality. Due to the increasing use of proton pump inhibitors (PPI) and H2 receptor inhibitors for stress ulcer prophylaxis, the purpose of the study was to investigate the differences of VAP in two groups of patients receiving PPI or H2 blocker.
Methods: In the retrospective cross sectional study, from September 2011 to September 2012, 43 patients who had positive pulmonary cultures (PC) were studied. These patients had a clinical pulmonary infection score (CPIS) ≥6 for more than 48 hours after receiving stress related mucosal diseases prophylaxis (SRMD). Patients whose SRMD prophylaxis was changed within 72 hours before obtaining the PC samples were excluded. Patients were divided into two groups. One group received pantoprazole (20 cases) and the other group received ranitidine (23 cases). Between the groups, age, sex, APACHE II score, predicted mortality, type of used SRMD prophylaxis drug, duration of prophylaxis prior to PC sampling, interval time between ICU admission and VAP manifestation, the type of bacterial causes of VAP, gastrointestinal bleeding, ICU length of stay and actual mortality were compared.
Results: The APACHE II score and predicted mortality were higher in the pantoprazole group (P=0.173, 0.167). We found that 30% of the ranitidine group suffered from upper GI bleeding. In the pantoprazole group, 21.74% suffered from upper GI bleeding (P<0.001). Patients receiving ranitidine had a higher mortality rate and a worse prognosis (P< 0.001).
Conclusion: Although there were more critically ill patients with a higher predicted mortality in the pantoprazole group, the ranitidine recipients turned out to have a higher mortality rate.