stress ulcer prophylaxis
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Management
- no benefit (or harm) of pantoprazole for stress ulcer prophylaxis[1]
- even high-risk patients may not benefit[2]
- no effect on hospital stay, ICU stay, mechanical ventilation or mortality but may prevent clinically significant upper GI bleeding[4][5][6]
- reserve proton pump inhibitor prophylaxis for
- critically ill patients with coagulopathy
- patients with a history of upper GI bleeding
- mechanical ventilation for > 48 hours[7]
- >= 2 risk factors (sepsis, high-dose glucocorticoid)
- proton-pump inhibitors prevent upper GI bleeding in critically ill patients & may limit mortality in less severely ill patients.[8]
* significant upper GI bleeding is relatively rare in critically ill patients[3]
More general terms
Additional terms
References
- ↑ 1.0 1.1 Selvanderan SP1, Summers MJ, Finnis ME et al Pantoprazole or Placebo for Stress Ulcer Prophylaxis (POP-UP): Randomized Double-Blind Exploratory Study. Crit Care Med. 2016 Oct;44(10):1842-50 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27635481
Marik PE Stress Ulcer Prophylaxis Deadoption: What is the Barrier? PMID: https://www.ncbi.nlm.nih.gov/pubmed/27635486 - ↑ 2.0 2.1 Cook D, Guyatt G. Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients. N Engl J Med 2018; 378:2506-2516. June 28, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29949497 https://www.nejm.org/doi/full/10.1056/NEJMra1605507
- ↑ 3.0 3.1 3.2 Krag M, Marker S, Perner A et al. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. N Engl J Med 2018 Oct 24; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30354950 Free Article
Barkun A, Bardou M. Proton-pump inhibitor prophylaxis in the ICU - Benefits worth the risks? N Engl J Med 2018 Oct 24; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30354949 Free Article - ↑ 4.0 4.1 Young PJ et al. Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital mortality among ICU patients receiving invasive mechanical ventilation: The PEPTIC randomized clinical trial. JAMA 2020 Jan 17; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31950977 https://jamanetwork.com/journals/jama/article-abstract/2759412
- ↑ 5.0 5.1 Wang Y et al. Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: Systematic review and network meta-analysis. BMJ 2020 Jan 6; 368:l6744 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31907166 https://www.bmj.com/content/368/bmj.l6744
- ↑ 6.0 6.1 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
- ↑ 7.0 7.1 NEJM Knowledge+ Gastroenterology
- ↑ 8.0 8.1 Cook D, Deane A, Lauzier F et al. Stress ulcer prophylaxis during invasive mechanical ventilation. N Engl J Med 2024 Jun 14; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/38875111 https://www.nejm.org/doi/10.1056/NEJMoa2404245
Wang Y, Parpia S, Ge L et al. Proton-pump inhibitors to prevent gastrointestinal bleeding - An updated meta-analysis. NEJM Evid. 2024 Jul;3(7):EVIDoa2400134 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38874580 https://evidence.nejm.org/doi/10.1056/EVIDoa2400134
Brown SM. Uncertain answers - Proton-pump inhibition in the ICU. N Engl J Med 2024 Jun 14; PMID: https://www.ncbi.nlm.nih.gov/pubmed/38875100 https://www.nejm.org/doi/10.1056/NEJMe2405782