Shiddapur Ami, Kistler Christine E, Busby-Whitehead Jan, Austin C Adrian
Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL.
Divison of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC.
Crit Care Explor. 2021 Aug 10;3(8):e0507. doi: 10.1097/CCE.0000000000000507. eCollection 2021 Aug.
Histamine-2 receptor antagonists are commonly administered for stress ulcer prophylaxis in critically ill adults and may be associated with delirium development. We aimed to determine differential associations of histamine-2 receptor antagonist or proton-pump inhibitor administration with delirium development in patients admitted to a medical ICU.
Retrospective observational study using a deidentified database sourced from the University of North Carolina Health Care system. Participants were identified as having delirium utilizing an -based algorithm. Associations among histamine-2 receptor antagonist, proton-pump inhibitor, or no medication administration and delirium were identified using relative risk. Multiple logistic regression was used to control for potential confounders including mechanical ventilation and age.
Academic tertiary care medical ICU in the United States.
Adults admitted to the University of North Carolina medical ICU from January 2015 to December 2019, excluding those on concurrent histamine-2 receptor antagonists and proton-pump inhibitors in the same encounter.
None.
We identified 6,645 critically ill patients, of whom 29% ( = 1,899) received mechanical ventilation, 45% ( = 3,022) were 65 or older, and 22% ( = 1,487) died during their medical ICU encounter. Of the 6,645 patients, 31% ( = 2,057) received an histamine-2 receptor antagonist and no proton-pump inhibitors, 40% ( = 2,648) received a proton-pump inhibitor and no histamine-2 receptor antagonists, and 46% ( = 3,076) had delirium. The histamine-2 receptor antagonist group had a greater association with delirium than the proton-pump inhibitor group compared with controls receiving neither medication, after controlling for mechanical ventilation and age (risk ratio, 1.36; 1.25-1.47; < 0.001) and (risk ratio, 1.15; 1.07-1.24; < 0.001, respectively).
Histamine-2 receptor antagonists are more strongly associated with increased delirium than proton-pump inhibitors. Prospective studies are necessary to further elucidate this association and to determine if replacement of histamine-2 receptor antagonists with proton-pump inhibitors in ICUs decreases the burden of delirium in critically ill patients.
组胺-2受体拮抗剂常用于危重症成年患者的应激性溃疡预防，可能与谵妄的发生有关。我们旨在确定在入住内科重症监护病房（ICU）的患者中，使用组胺-2受体拮抗剂或质子泵抑制剂与谵妄发生之间的差异关联。
一项回顾性观察研究，使用来自北卡罗来纳大学医疗系统的去识别数据库。利用基于[具体算法名称未给出]的算法将参与者确定为患有谵妄。使用相对风险来确定组胺-2受体拮抗剂、质子泵抑制剂或未用药与谵妄之间的关联。采用多因素逻辑回归来控制包括机械通气和年龄在内的潜在混杂因素。
美国一所学术性三级医疗内科ICU。
2015年1月至2019年12月入住北卡罗来纳大学内科ICU的成年人，排除在同一次住院期间同时使用组胺-2受体拮抗剂和质子泵抑制剂的患者。
无。
我们确定了6645名危重症患者，其中29%（n = 1899）接受了机械通气，45%（n = 3022）年龄在65岁及以上，22%（n = 1487）在其内科ICU住院期间死亡。在这6645名患者中，31%（n = 2057）接受了组胺-2受体拮抗剂且未使用质子泵抑制剂，40%（n = 2648）接受了质子泵抑制剂且未使用组胺-2受体拮抗剂，46%（n = 3076）发生了谵妄。在控制了机械通气和年龄后，与既未使用这两种药物的对照组相比，组胺-2受体拮抗剂组与谵妄的关联比质子泵抑制剂组更强（风险比分别为1.36；95%置信区间为1.25 - 1.47；P < 0.001）和（风险比为1.15；95%置信区间为1.07 - 1.24；P < 0.001）。
与质子泵抑制剂相比，组胺-2受体拮抗剂与谵妄增加的关联更强。需要进行前瞻性研究以进一步阐明这种关联，并确定在ICU中用质子泵抑制剂替代组胺-2受体拮抗剂是否能减轻危重症患者的谵妄负担。
