DOI: 10.1097/01.ccm.0000474207.51182.ff
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Issn Print: 0090-3493
Publication Date: 2015/12/01
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Excerpt
Methods: Medical ICU patients gathered from February to March 2015 were compared to a retrospective historical control within the same ICU. Patients in the historical control received pantoprazole concurrent with enteral nutrition, while patients in the prospective study group had pantoprazole discontinued when enteral feed rates reached 30 ml/hr. Patients were included if >18 yr of age, mechanically ventilated >48h, ICU stay >72h, and were receiving concurrent pantoprazole and enteral nutrition. Patients with an active or high suspicion of GI bleed; those admitted for surgical GI procedure, TBI, major burns; and those with history of liver disease, varices, PUD, or Barrett’s esophagus were excluded. The primary outcome was the occurrence of clinically significant GI bleeds. Secondary outcomes included rates of complications (HCAP, C.difficile, length of stays, and mortality).
Results: The historical control group included 63 patients, and the prospective study group included 8 patients. There was no difference in age or gender between the groups. The control group had a larger percentage of GI bleeds, pneumonia, and C.difficile infections (1.59 vs 0), (4.8 vs 0), (6.4 vs 0). The total LOS was 16 vs 10 days, but there was no difference in ICU LOS or duration of ventilation. Inpatient mortality did not differ between the groups (0.29 vs 0.38).
Conclusions: Although the study numbers are small and did not reach statistical significance, the prospective group did not appear to have increased morbidity or mortality with stopping pantoprazole once enteral feeds reached 30 ml/hr. Additional prospective studies are needed to support discontinuation of AST when enteral feeds are 30 ml/hr. This practice may prove to limit the adverse effects of AST and reduce unnecessary costs to the ICU patient.
