No Difference in Mortality with Stress Ulcer Prophylaxis in Critically Ill Patients

Critical care guidelines recommend stress ulcer prophylaxis, usually with proton-pump inhibitors (PPIs), for specific cohorts of intensive care unit (ICU) patients. However, in recent years, concerns have been raised about potential adverse effects of PPIs, including excess risk for pneumonia, myocardial ischemia, and Clostridium difficile infection.

An international group of investigators randomized 3300 critically ill patients to receive either pantoprazole or placebo, continued until ICU discharge or death. All patients had at least one risk factor for gastrointestinal (GI) bleeding, including shock, anticoagulation, renal replacement therapy, liver failure, coagulopathy, or mechanical ventilation. More than half of patients received ente…