Gastric Acid Suppressant Prophylaxis in Pediatric Intensive Care: Current Practice as Reflected in a Large Administrative Database.
Gastric Acid Suppressant Prophylaxis in Pediatric Intensive Care: Current Practice as Reflected in a Large Administrative Database.
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儿科重症监护中的胃酸抑制剂预防：大型管理数据库中反映的当前实践。
DOI：
10.1097/pcc.0000000000000427
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Guevara,JamesP
中科院分区：
文献类型：
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作者：
Costarino,AndrewT;Dai,Dingwei;Feng,Rui;Feudtner,Chris;Guevara,JamesP
目的：PICU患者可能发生应激相关性消化道出血。用抑酸药物提高胃pH值是公认的治疗方法。我们描述了使用组胺2受体阻滞剂和质子泵抑制剂和相关因素之间的国家样本的PICU patients.Design：回顾性队列分析使用儿科健康信息系统临床详细的行政数据库设置：42个儿童医院在整个美国患者：所有住院的所有患者20岁或以下，直接承认一个PICU，从2007年1月1日，通过2011年12月31日干预：无测量和主要结果：关注的暴露是在PICU入院的第一天接受组胺2受体阻滞剂、质子泵抑制剂或两者治疗。评估了人口统计学、主要和附加诊断以及手术代码。对于每次住院，确定了主要诊断、凝血障碍、头部创伤、脊柱创伤、严重烧伤、败血症、胃肠道出血、机械通气、血液制品输注和10种复杂慢性疾病。确定主要诊断的频率，以确定最流行的PICU疾病。抑酸剂的使用分为高或低。对33.6万10例住院患者进行了抽样调查。组胺2受体阻滞剂或质子泵抑制剂的使用率为60.0%，组胺2受体阻滞剂单独使用率为70.4%，质子泵抑制剂单独使用率为17.8%，两种药物联合使用率为11.8%。在2007至2011年的抽样年份，使用量有所增加。1.32%的住院患者发生胃肠道出血，0.1%需要输血。在最常见的诊断中，组胺2受体阻滞剂和质子泵抑制剂的使用范围为33%至87%。脓毒症、凝血障碍和机械通气使用率较高。结论：PICU患者中组胺2受体阻滞剂和质子泵抑制剂的使用率较高，但不同健康状况和不同医院的PICU患者中组胺2受体阻滞剂和质子泵抑制剂的使用率差异较大。制度偏好可能会影响变异。消化道出血在当今时代并不常见。研究数据的局限性阻碍了对药物使用与患者结局之间关系的研究。
Objectives:Stress-related gastrointestinal bleeding may occur in PICU patients. Raising gastric pH with acid suppressant medications is the accepted treatment. We describe the use of histamine 2 receptor blockers and proton pump inhibitors and associated factors among a national sample of PICU patients.Design:Retrospective cohort analysis using Pediatric Health Information System clinically detailed administrative database.Setting:Forty-two children’s hospitals throughout the United States.Patients:All hospitalizations for all patients 20 years old or younger, admitted directly to a PICU, from January 1, 2007, through December 31, 2011.Interventions:None.Measurements and Main Results:The exposure of interest was treatment with a histamine 2 receptor blocker, proton pump inhibitor, or both on the first day of PICU admission. Demographics, principal and additional diagnoses, and procedure codes were assessed. For each hospitalization, principal diagnosis, coagulation disorder, head trauma, spinal trauma, severe burns, sepsis, gastrointestinal hemorrhage, mechanical ventilation, blood product transfusion, and 10 complex chronic conditions were identified. The frequency of principal diagnoses was determined to identify the most prevalent PICU diseases. Acid suppressant use was categorized as high or low. Three hundred and thirty-six thousand ten inpatient hospitalizations were sampled. Histamine 2 receptor blocker or proton pump inhibitor was used in 60.0%, with histamine 2 receptor blocker alone in 70.4%, proton pump inhibitor alone in 17.8%, and both agents in 11.8%. Use increased over the sample years 2007 through 2011. Gastrointestinal bleeding occurred in 1.32% of hospitalizations with transfusion needed in 0.1%. Among most prevalent diagnoses, histamine 2 receptor blocker and proton pump inhibitor use ranged from 33% to 87%. Sepsis, coagulopathy, and mechanical ventilation identified higher use. Use of histamine 2 receptor blocker or proton pump inhibitor among hospitals varied considerably ranging from 28% to 87%.Conclusions:Histamine 2 receptor blocker and proton pump inhibitor are prescribed in most PICU patients, but significant variation exists across health conditions and hospitals. Institutional preferences likely influence variation. Gastrointestinal hemorrhage is infrequent in the current era. Study data limitations prevent examination of associations between medication use and patient outcomes.