title: Case report: the effect of proton pump inhibitor administration on hemodynamics in a cardiac intensive care unit.
abstract: Ex vivo studies have suggested that high dose proton pump inhibitors (PPI) may have negative inotropic effects in myocardial tissue. We sought to investigate this concept in a real-world clinical setting. In this case series, we enrolled critically ill patients in the coronary and cardiothoracic intensive care units who had a preexisting pulmonary artery (PA) catheter in place for hemodynamic monitoring and were on a PPI for prespecified clinical indications. Hemodynamic measurements were made at baseline and then at 15 minute intervals for 1 hour after PPI administration. A total of 18 patients were evaluated; 72% were male with a mean age of 59.9 years. A total of 9 patients were evaluated on 2 consecutive days, yielding 26 patient-exposures to the medication. The majority of patients (72%) were receiving 1 or more inotropic agents (n = 6), a vasopressor (n = 4), or both (n = 4). When compared to baseline values, there was no significant change in mean arterial pressure (baseline 80 +/- 11 mm Hg), heart rate (87 +/- 11 bpm), or Fick cardiac index (2.7 +/- 1.8 L/min/m(2)). Mean PA pressure did decrease transiently at 45 minutes following PPI administration (28.5 +/- 7.7 mm Hg at baseline vs 26.5 +/- 7.5 mm Hg, P = 0.017), but is unlikely to be of clinical significance. In conclusion, these data suggest that IV PPIs do not immediately impact important hemodynamic parameters and are likely safe in a high-risk intensive care setting.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA. amanion@med.umich.edu
authors.forename: Anna M
authors.initials: AM
authors.lastname: Booher
authors.forename: Michael
authors.initials: M
authors.lastname: Dorsch
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002407:Catheterization, Swan-Ganz; D003325:Coronary Care Units; D003422:Critical Care; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D054328:Proton Pump Inhibitors