Gastroenterology in critical care · Stress ulcer prophylaxis
Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation
| Design | Multicentre randomised controlled trial in 68 ICUs |
|---|---|
| Treatment | Intravenous pantoprazole |
| Control | Placebo |
| Population | 4821 patients undergoing invasive mechanical ventilation |
| Follow-up | 90 days |
| Primary endpoint | Clinically important upper gastrointestinal bleeding |
| Result | Clinically important upper gastrointestinal bleeding occurred in 25 of 2385 (1.0%) receiving pantoprazole and 84 of 2377 (3.5%) receiving placebo, with no significant effect on mortality. |
| Secondary endpoints | 90-day mortality, ventilator-associated pneumonia, Clostridioides difficile infection |
Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo, with no significant effect on mortality.
The trial authors, in the published abstract
Definitively re-establishes stress ulcer prophylaxis after years of doubt about whether modern enterally fed patients still need it. The absence of a mortality signal in either direction is reassuring on the infection concerns that drove the doubt.
Cook D, Deane A, Lauzier F, et al. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med 2024 Jul 4;391(1):9-20.