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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

Effect of Stress Ulcer Prophylaxis With Proton Pump Inhibitors vs Histamine-2 Receptor Blockers... Key PointsQuestionWhat is the comparative effect on in-hospital mortality of using proton pump inhibitors (PPIs) vs histamine-2 receptor blockers (H2RBs) for stress ulcer prophylaxis among adults requiring invasive mechanical ventilation in the intensive care unit (ICU)? FindingsIn this cluster crossover randomized clinical trial, 26 982 patients requiring invasive mechanical ventilation within 24 hours of ICU admission were randomized by site at 50 ICUs in 5 countries to a PPI strategy or an H2RB strategy for stress ulcer prophylaxis. In-hospital mortality was 18.3% for patients treated at sites randomized to PPI use vs 17.5% for those treated at sites randomized to H2RB use, a difference that did not reach statistical significance (P = .054). Among patients treated at sites randomized to PPIs, 4.1% received H2RBs; among patients treated at sites randomized to H2RBs, 20.1% received PPIs. MeaningA strategy of use with PPIs vs H2RBs for stress ulcer prophylaxis among adults requiring mechanical ventilation did not result in a statistically significant difference for in-hospital mortality, but study interpretation may be limited by crossover in medication use. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

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

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References (22)

Publisher
American Medical Association
Copyright
Copyright 2020 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2019.22190
Publisher site
See Article on Publisher Site

Abstract

Key PointsQuestionWhat is the comparative effect on in-hospital mortality of using proton pump inhibitors (PPIs) vs histamine-2 receptor blockers (H2RBs) for stress ulcer prophylaxis among adults requiring invasive mechanical ventilation in the intensive care unit (ICU)? FindingsIn this cluster crossover randomized clinical trial, 26 982 patients requiring invasive mechanical ventilation within 24 hours of ICU admission were randomized by site at 50 ICUs in 5 countries to a PPI strategy or an H2RB strategy for stress ulcer prophylaxis. In-hospital mortality was 18.3% for patients treated at sites randomized to PPI use vs 17.5% for those treated at sites randomized to H2RB use, a difference that did not reach statistical significance (P = .054). Among patients treated at sites randomized to PPIs, 4.1% received H2RBs; among patients treated at sites randomized to H2RBs, 20.1% received PPIs. MeaningA strategy of use with PPIs vs H2RBs for stress ulcer prophylaxis among adults requiring mechanical ventilation did not result in a statistically significant difference for in-hospital mortality, but study interpretation may be limited by crossover in medication use.

Journal

JAMA – American Medical Association

Published: Feb 18, 2020

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