Critically ill patients admitted to the intensive care unit (ICU) are at risk of developing gastrointestinal (GI) bleeding owing to stress ulcers, which is associated with a prolonged length of stay (LOS) in the ICU and an increased risk of death.
- To prevent GI bleeding in these critically ill patients, ICU doctors frequently prescribe stress ulcers prophylaxis (SUP).
- Proton pump inhibitors (PPIs) and histamine type 2 receptor blockers (H2Bs) are the most commonly used SUP agents.
- Sepsis has been considered a risk factor for the development of stress ulceration and GI bleeding for many years, and SUP is recommended by the Surviving Sepsis Campaign guidelines for patients with sepsis or septic shock who have risk factors for GI bleeding.
- Although these guidelines further recommend either H2Bs or PPIs when SUP is indicated, there is limited evidence of the effects of H2Bs in comparison with PPIs when used as SUP in critically ill patients with sepsis.
- A recent meta-analysis of a general population of patients in the ICU suggested that PPIs are the most effective agents in preventing clinically important GI bleeding. However, two retrospective studies found that PPIs were associated with a higher rate of GI bleeding than H2Bs.
- In clinical practice, PPIs are more commonly prescribed by critical care providers, possibly because of their superior acid suppression capability in comparison with H2Bs.
- However, PPI use is not without risk. Some studies have shown that patients receiving PPIs have a higher risk of nosocomial pneumonia, Clostridium difficile infection(CDI), and myocardial infarction.
- Accordingly, it is reasonable to evaluate the comparative effects of SUP using PPIs and H2Bs on important outcomes in patients with severe sepsis or septic shock.
- A retrospective cohort study compares two strategies for SUP among adult patients with sepsis or septic shock who have risk factors for GI bleeding.
- Specifically, hypothesized that PPIs are associated with a lower occurrence of GI bleeding and in-hospital mortality than H2Bs but may increase the risk of pneumonia and CDI.
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All animals are heterotrophs as in they can't produce their own energy like plants can which is why they are autotrophs. Herbivores eat plants, carnivores eat animals, and omnivores (humans) eat both.
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Organisms depend on other members of an ecosystem to live and grow. For example, in a symbiosis, buffalo birds will lay eggs in the nest of other birds. These chicks then depend on the parent birds to raise them.
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