Two Studies on Strategies for Stress Ulcer Prophylaxis

Much of critical care practice is avoiding nosocomial infections and other complications. In the past few years, studies have shed new light on “established” preventive practices. One area of reexamination is the best approach to stress ulcer prophylaxis.

In an international trial, investigators randomized nearly 27,000 mechanically ventilated patients from 50 intensive care units to proton-pump inhibitors (PPIs) or histamine-2 (H₂)–receptor blockers for stress ulcer prophylaxis. About 20% of patients randomized to H₂-receptor blockers received PPIs, and 4% of patients randomized to PPIs received H₂-receptor blockers. In-hospital mortality and length of stay did not differ between groups. Clinically important gastrointestinal bleeding was ra…