In patients receiving invasive ventilation, PPIs reduce upper GI bleeding but did not affect mortality at 90 d.

Area of Science:

• Critical Care Medicine
• Gastroenterology
• Pharmacology

Background:

• Stress ulcer prophylaxis is commonly used in critically ill patients.
• The benefits and harms of stress ulcer prophylaxis in mechanically ventilated patients are debated.

Purpose of the Study:

• To evaluate the efficacy and safety of stress ulcer prophylaxis in patients receiving invasive mechanical ventilation.

Main Methods:

• Randomized controlled trial (REVISE trial) involving mechanically ventilated patients.
• Comparison of stress ulcer prophylaxis (pantoprazole) versus placebo.
• Primary outcomes included clinically important gastrointestinal bleeding and in-hospital mortality.

Main Results:

• No significant difference in the rate of clinically important gastrointestinal bleeding between the prophylaxis and placebo groups.
• No significant difference in in-hospital mortality between the groups.
• Increased rates of pneumonia in the prophylaxis group.

Conclusions:

• Stress ulcer prophylaxis is not associated with reduced gastrointestinal bleeding or mortality in mechanically ventilated patients.
• Routine stress ulcer prophylaxis may increase the risk of pneumonia.