Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study

Shiddapur, Ami; Kistler, Christine E.; Busby‐Whitehead, Jan; Austin, Charles

doi:10.1097/cce.0000000000000507

Cited by 6 publications

(1 citation statement)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The risk for adverse effects has been highlighted in other studies evaluating acid suppressive therapy for SUP. One large retrospective study described an increase in delirium in patients exposed to H2RAs or PPIs compared to controls who were not receiving either medication [12]. Some studies have shown an association between PPIs and infectious complications [13,14].…”

Section: Medications Used For Stress Ulcer Prophylaxismentioning

confidence: 99%

Prophylactic acid suppression and enteral nutrition

Barletta¹

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

View full text Add to dashboard Cite

Purpose of reviewStress ulcer prophylaxis (SUP) is routinely administered to critically ill patients who are at high-risk for clinically important gastrointestinal bleeding. Recent evidence however has highlighted adverse effects with acid suppressive therapy, particularly proton pump inhibitors where associations with higher mortality have been reported. Enteral nutrition may provide benefits in reducing the incidence of stress ulceration and may mitigate the need for acid suppressive therapy. This manuscript will describe the most recent evidence evaluating enteral nutrition for the provision of SUP.Recent findingsThere are limited data evaluating enteral nutrition for SUP. The available studies compare enteral nutrition with or without acid suppressive therapy rather than enteral nutrition vs. placebo. Although data exist demonstrating similar clinically important bleeding rates in patients on enteral nutrition who receive SUP vs. no SUP, these studies are underpowered for this endpoint. In the largest placebo-controlled trial conducted to date, lower bleeding rates were observed with SUP and most patients were receiving enteral nutrition. Pooled analyses had also described benefit with SUP vs. placebo and enteral nutrition did not change the impact of these therapies.SummaryAlthough enteral nutrition may provide some benefit as SUP, existing data are not strong enough to validate their use in place of acid suppressive therapy. Clinicians should continue to prescribe acid suppressive therapy for SUP in critically ill patients who are at high risk for clinically important bleeding even when enteral nutrition is being provided.

show abstract

Section: Medications Used For Stress Ulcer Prophylaxismentioning

confidence: 99%