Background and importance Proton pump inhibitors (PPIs) are regularly prescribed in the paediatric intensive care unit (PICU) for prevention of stress ulcer and upper gastrointestinal bleed (UGIB). There is no clinical consensus regarding PPI use in the PICU. The reported incidence of UGIB in the PICU is low (0.4–5%). Having ≥2 risk factors has been associated with a higher risk of clinically relevant UGIB in the PICU (severity score at admission PRISM >10, coagulopathy, mechanical ventilation). Despite identification of these risk factors, studies fail to show that stress ulcer prophylaxis significantly decreases UGIB in the PICU. Moreover, recent studies in mostly adult patients have associated PPIs in the acute setting to a higher risk of nosocomial infections and hyponatraemia.
Aim and objectives To describe PPI prescription patterns in the PICU and explore potentially associated clinical complications such as nosocomial infections and hyponatraemia.
Material and methods A single centre, retrospective, cohort study was conducted on PICU patient charts from 1 January 2017 to 31 December 2018.
Results 768 patients were included of whom 234 received a PPI (30.6%). PPI exposed patients were younger (p<0.05), weighted less (p<0.05) and were more likely to have had surgery (p<0.05), a central venous access (p<0.05), parenteral nutrition (p<0.05), coagulopathy (p<0.05), mechanical ventilation (p<0.05) and a longer PICU stay (p<0.05). The most common indication for PPI was stress ulcer prophylaxis (n=178, 76.1%) but only 12.4% (n=22) had ≥2 UGIB risk factors. Nosocomial infection rate was 9.4% in the PPI group versus 2.2% in the non-exposed group (RR=3.40 (95% CI 1.76 to 6.57), p<0.05). Once adjusted for confounding variables, PPI exposure was independently associated with a higher risk for nosocomial infection (ORa=2.42 (95% CI 1.17 to 5.14), p=0.02). PPI exposure was associated with an increased risk of hyponatraemia (RR=5.18 (95% CI 2.16 to 12.43), p<0.05).
Conclusion and relevance Our study showed an overuse of PPIs in our PICU, with poorly documented indications. PPIs were statistically and independently associated with an increased risk of nosocomial infections in our population. Prospective randomised trials are needed to evaluate the risk–benefit ratio of PPIs in the PICU. Our results suggest the need for a more rational use of PPIs in the PICU and highlight the lack of clinical guidelines and safety data regarding stress ulcer prophylaxis in critically ill children
Conflict of interest No conflict of interest