Stress Ulcer Bleeding Prophylaxis in the Intensive Care Unit

The incidence of clinically important stress ulcer gastrointestinal (GI) bleeding in the intensive care unit (ICU) is decreasing. Concerns about tradeoffs between potential benefits and harms of prophylaxis with proton-pump inhibitors (PPIs) were addressed in a large randomized trial that was published in 2018. About 3300 critically ill, at-risk patients (i.e., >24 hours mechanical ventilation, shock, coagulopathy or use of anticoagulants, chronic renal replacement therapy, or chronic liver disease) received either pantoprazole prophylaxis or placebo. Nearly 60% of patients received enteral feeding on ICU day 1, and >80% received feeding by ICU day 3. GI bleeding occurred in 2.5% of patients who received PPIs versus 4.2% who received placeb…