Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation.

Link: https://doi.org/10.1056/NEJMoa2404245
Authors: Cook, Deborah; Deane, Adam; Lauzier, François; Zytaruk, Nicole; Guyatt, Gordon; Saunders, Lois; Hardie, Miranda; Heels-Ansdell, Diane; Alhazzani, Waleed; Marshall, John; Muscedere, John; Myburgh, John; English, Shane; Arabi, Yaseen M; Ostermann, Marlies; Knowles, Serena; Hammond, Naomi; Byrne, Kathleen M; Chapman, Marianne; Venkatesh, Balasubramanian; Young, Paul; Rajbhandari, Dorrilyn; Poole, Alexis; Al-Fares, Abdulrahman; Reis, Gilmar; Johnson, Daniel; Iqbal, Mobeen; Hall, Richard; Meade, Maureen; Hand, Lori; Duan, Erick; Clarke, France; Dionne, Joanna C; Tsang, Jennifer L Y; Rochwerg, Bram; Karachi, Timothy; Lamontagne, Francois; D’Aragon, Frédérick; St Arnaud, Charles; Reeve, Brenda; Geagea, Anna; Niven, Daniel; Vazquez-Grande, Gloria; Zarychanski, Ryan; Ovakim, Daniel; Wood, Gordon; Burns, Karen E A; Goffi, Alberto; Wilcox, M Elizabeth; Henderson, William; Forrest, David; Fowler, Rob; Adhikari, Neill K J; Ball, Ian; Mele, Tina; Binnie, Alexandra; Trop, Sebastien; Mehta, Sangeeta; Morgan, Ingrid; Loubani, Osama; Vanstone, Meredith; Fiest, Kirsten; Charbonney, Emmanuel; Cavayas, Yiorgos A; Archambault, Patrick; Rewa, Oleksa G; Lau, Vincent; Kristof, Arnold S; Khwaja, Kosar; Williamson, David; Kanji, Salmaan; Sy, Eric; Dennis, Brittany; Reynolds, Steve; Marquis, Francois; Lellouche, François; Rahman, Adam; Hosek, Paul; Barletta, Jeffrey F; Cirrone, Robert; Tutschka, Mark; Xie, Feng; Billot, Laurent; Thabane, Lehana; Finfer, Simon; ,

Abstract: Whether proton-pump inhibitors are beneficial or harmful for stress ulcer prophylaxis in critically ill patients undergoing invasive ventilation is unclear. A total of 4821 patients underwent randomization in 68 ICUs. Clinically important upper gastrointestinal bleeding occurred in 25 of 2385 patients (1.0%) receiving pantoprazole and in 84 of 2377 patients (3.5%) receiving placebo (hazard ratio, 0.30; 95% confidence interval [CI], 0.19 to 0.47; P<0.001). At 90 days, death was reported in 696 of 2390 patients (29.1%) in the pantoprazole group and in 734 of 2379 patients (30.9%) in the placebo group (hazard ratio, 0.94; 95% CI, 0.85 to 1.04; P = 0.25). Patient-important bleeding was reduced with pantoprazole; all other secondary outcomes were similar in the two groups. 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. (Funded by the Canadian Institutes of Health Research and others; REVISE ClinicalTrials.gov number, NCT03374800.).