Abstract
Background. Stress-related mucosal damage is an erosive process of the gastric lining resulting from abnormally high physiologic demands. To avoid the morbidity and mortality associated with significant bleeding from the damage, prophylaxis with an acid suppression medication is given. This is especially common in stroke victims. Recent studies have suggested a link between acid suppression therapy and nosocomial pneumonia, specifically implicating proton pump inhibitors (PPI), a potent acid suppression medication, as the culprit. In this retrospective study, we reviewed the medical records of admitted intracerebral hemorrhage (ICH) patients and determined if there is a link between PPI prophylaxis and nosocomial pneumonia in our ICH population. Materials and Methods. Medical records of 200 ICH patients admitted to the First Affiliated Hospital of Chongqing Medical University were reviewed from January 1, 2008 to October 31, 2009. PPIs were the only accepted form of acid suppression therapy. In all, 95 patients were given PPI prophylaxis, whereas 105 patients did not receive any form of acid suppression. Results. The unadjusted incidence rate of pneumonia in the PPI prophylactic group was 23.2%, and 10.5% in patients not having received prophylaxis. Additionally, patients treated with PPI prophylaxis were more likely to be critically ill, defined by an increase in conscious disturbance and dependency on mechanical ventilation and/or a nasogastric tube.
Conclusion. The use of a PPI as a prophylactic treatment against stress-related mucosal damage was associated with a higher occurrence of nosocomial pneumonia in our ICH population. This study suggests the need for further research investigating the use of PPI prophylaxis in ICH patients and the possibility of using alternate acid suppression therapeutic modalities.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Jung R, MacLaren R (2002) Proton-pump inhibitors for stress ulcer prophylaxis in critically ill patients. Ann Pharmacother 36(12):1929–37
Smythe MA, Zarowitz BJ (1994) Changing perspectives of stress gastritis prophylaxis. Ann Pharmacother 28(9):1073–85
Lucas CE et al (1971) Natural history and surgical dilemma of “stress” gastric bleeding. Arch Surg 102(4):266–73
Misra UK, Kalita J, Pandey S, Mandal SK, Srivastava M (2004) A randomized placebo controlled trial of ranitidine versus sucralfate in patients with spontaneous intracerebral hemorrhage for prevention of gastric hemorrhage. J Neurol Sci 239:5–10
Cook DJ et al (1991) Stress ulcer prophylaxis in the critically ill: a meta-analysis. Am J Med 91(5):519–27
Lacroix J et al (1989) Prophylaxis of upper gastrointestinal bleeding in intensive care units: a meta-analysis. Crit Care Med 17(9):862–9
Tryba M (1991) Prophylaxis of stress ulcer bleeding. A meta-analysis. J Clin Gastroenterol 13(13 Suppl 2):S44–55
Herzig SJ et al (2009) Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA 301(20):2120–8
Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia http://www.cdc.gov/mmwr/preview/mmwrhtml/00045365.htm
Cook DJ et al (1996) Stress ulcer prophylaxis in critically ill patients resolving discordant metaanalyses. JAMA 275(4):308–14
Reilly J, Fennerty MB (1998) Stress Ulcer prophylaxis: the prevention of gastrointestinal bleeding and the development of nosocomial infections in critically ill patients. J Pharm Prac 11:p. 418–432
Spirt MJ (2003) Acid suppression in critically ill patients: what does the evidence support? Pharmacotherapy 23(10 Pt 2):87S–93S
Maramattom BV et al (2006) Pulmonary complications after intracerebral hemorrhage. Neurocrit Care 5(2):115–9
Miano TA et al (2009) Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest 136(2):440–7
Atherton ST, White DJ (1978) Stomach as source of bacteria colonising respiratory tract during artificial ventilation. Lancet 2(8097):968–9
du Moulin GC et al (1982) Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet 1(8266):242–5
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag/Wien
About this chapter
Cite this chapter
Ran, L., Khatibi, N.H., Qin, X., Zhang, J.H. (2011). Proton Pump Inhibitor Prophylaxis Increases the Risk of Nosocomial Pneumonia in Patients with an Intracerebral Hemorrhagic Stroke. In: Zhang, J., Colohan, A. (eds) Intracerebral Hemorrhage Research. Acta Neurochirurgica Supplementum, vol 111. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0693-8_75
Download citation
DOI: https://doi.org/10.1007/978-3-7091-0693-8_75
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-0692-1
Online ISBN: 978-3-7091-0693-8
eBook Packages: MedicineMedicine (R0)