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Master Thesis

Revue de l’utilisation des inhibiteurs de la pompe à protons en réanimation pédiatrique et exploration des complications associées

Abstract : Proton pump inhibitors (ppi) are prescribed in the pediatric intensive care unit (picu) for stress ulcer prophylaxis (sup) and associated upper gastro-intestinal bleeding (ugib). Mechanical ventilation, prism (pediatric risk of mortality) score > 10 or coagulopathy are associated with a higher risk of ugib. Ppi prescription for sup is being questioned because of the lack of evidence regarding efficacy and the potential effect on nosocomial pneumoniae. We realised a single center retrospective study in the picu over a 2 years period, from january 1st 2017 to december 31st 2018. 754 patients were included. 231 (30.6%) received a ppi. Patients who received ppi were older, weighted more and were more likely to have had surgery, a central venous access, parenteral nutrition, coagulopathy, mechanical ventilation and had a longer picu-stay (p<0.05). The most common indication for ppi prescription was sup (n=177.77%); but only 12% (n=22) had ugib risk factors. 8.2% of the patients exposed to ppi developped a nosocomial infection vs 1.7% in the non exposed group. This difference was statisticly significant (rr=3.40 [ic95% 1.76-6.57], p<0.05) and remained significant after adjusting for potential confounders (ora=2.42 [ic95% 1.17-5.14], p=0.02) as well as with propensity score matching analysis (p=0.031). Ppi exposure was also associated with hyponatremia (rr=5.18 [ic95% 2.16-12.43], p<0.05). This study showed a misuse of ppi in the picu with an associated risk of nosocomial infection and hyponatremia this study showed a misuse of ppi in the picu with an associated risk of nosocomial infection and hyponatremia.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03608298
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Submitted on : Monday, March 14, 2022 - 4:17:09 PM
Last modification on : Saturday, May 14, 2022 - 3:40:25 AM

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  • HAL Id : dumas-03608298, version 1

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Julien Montreuil. Revue de l’utilisation des inhibiteurs de la pompe à protons en réanimation pédiatrique et exploration des complications associées. Sciences pharmaceutiques. 2021. ⟨dumas-03608298⟩

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