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Prophylactic Proton Pump Inhibitors in Critically Ill Patients Undergoing Invasive Ventilation: A Systematic Review
1Department of Adult Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China, uestc.edu.cn.
Critical Care Research and Practice
|June 8, 2026
Summary
Proton pump inhibitors (PPIs) effectively prevent upper gastrointestinal bleeding (UGIB) in critically ill, mechanically ventilated adults. This study found PPIs reduced UGIB risk without increasing mortality or other serious infections.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Pharmacology
Background:
- Critically ill patients on invasive ventilation are at high risk for upper gastrointestinal bleeding (UGIB).
- Prophylactic proton pump inhibitors (PPIs) are commonly used to prevent UGIB in this population, but their efficacy and safety require ongoing assessment.
Purpose of the Study:
- To evaluate the safety and efficacy of prophylactic PPIs in critically ill adults receiving invasive mechanical ventilation.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
- Searches included PubMed, Web of Science, Embase, and Cochrane Library up to September 19, 2024.
- Nine RCTs involving 8388 patients were analyzed using a random-effects model.
Main Results:
- Prophylactic PPIs significantly reduced the incidence of UGIB (OR: 0.42; 95% CI: 0.23-0.75) and clinically important UGIB (OR: 0.36; 95% CI: 0.19-0.69).
- No significant differences were observed in all-cause mortality (OR: 0.98; 95% CI: 0.89-1.07), ventilator-associated pneumonia, or Clostridioides difficile infection.
- Intensive care unit stay and ventilation duration remained comparable between groups.
Conclusions:
- Prophylactic PPI therapy is effective in reducing UGIB and clinically important UGIB in mechanically ventilated patients.
- PPI use in this setting does not appear to increase all-cause mortality or the risk of common respiratory or enteric infections.
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