Shane P Selvanderan1, Matthew J Summers, Mark E Finnis, Mark P Plummer, Yasmine Ali Abdelhamid, Michael B Anderson, Marianne J Chapman, Christopher K Rayner, Adam M Deane. 1. 1Discipline of Acute Care Medicine, the University of Adelaide, Adelaide, SA, Australia.2Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.3National Health and Medical Research Council of Australia Centre for Research Excellence in Nutritional Physiology and Outcomes, Adelaide, SA, Australia.4Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia.5Discipline of Medicine, the University of Adelaide, Adelaide, SA, Australia.
Abstract
OBJECTIVES:Pantoprazole is frequently administered to critically ill patients for prophylaxis against gastrointestinal bleeding. However, comparison to placebo has been inadequately evaluated, and pantoprazole has the potential to cause harm. Our objective was to evaluate benefit or harm associated with pantoprazole administration. DESIGN: Prospective randomized double-blind parallel-group study. SETTING: University-affiliated mixed medical-surgical ICU. PATIENTS: Mechanically ventilated critically ill patients suitable for enteral nutrition. INTERVENTIONS: We randomly assigned patients to receive either daily IV placebo or pantoprazole. MEASUREMENTS AND MAIN RESULTS: Major outcomes were clinically significant gastrointestinal bleeding, infective ventilator-associated complication or pneumonia, and Clostridium difficile infection; minor outcomes included overt bleeding, hemoglobin concentration profiles, and mortality. None of the 214 patients randomized had an episode of clinically significant gastrointestinal bleeding, three patients met the criteria for either an infective ventilator-associated complication or pneumonia (placebo: 1 vs pantoprazole: 2), and one patient was diagnosed with Clostridium difficile infection (0 vs 1). Administration of pantoprazole was not associated with any difference in rates of overt bleeding (6 vs 3; p = 0.50) or daily hemoglobin concentrations when adjusted for transfusion rates of packed red cells (p = 0.66). Mortality was similar between groups (log-rank p = 0.33: adjusted hazard ratio for pantoprazole: 1.68 [95% CI, 0.97-2.90]; p = 0.06). CONCLUSIONS: We found no evidence of benefit or harm with the prophylactic administration of pantoprazole to mechanically ventilated critically ill patients anticipated to receive enteral nutrition. The practice of routine administration of acid-suppressive drugs to critically ill patients for stress ulcer prophylaxis warrants further evaluation.
RCT Entities:
OBJECTIVES:Pantoprazole is frequently administered to critically illpatients for prophylaxis against gastrointestinal bleeding. However, comparison to placebo has been inadequately evaluated, and pantoprazole has the potential to cause harm. Our objective was to evaluate benefit or harm associated with pantoprazole administration. DESIGN: Prospective randomized double-blind parallel-group study. SETTING: University-affiliated mixed medical-surgical ICU. PATIENTS: Mechanically ventilated critically illpatients suitable for enteral nutrition. INTERVENTIONS: We randomly assigned patients to receive either daily IV placebo or pantoprazole. MEASUREMENTS AND MAIN RESULTS: Major outcomes were clinically significant gastrointestinal bleeding, infective ventilator-associated complication or pneumonia, and Clostridium difficileinfection; minor outcomes included overt bleeding, hemoglobin concentration profiles, and mortality. None of the 214 patients randomized had an episode of clinically significant gastrointestinal bleeding, three patients met the criteria for either an infective ventilator-associated complication or pneumonia (placebo: 1 vs pantoprazole: 2), and one patient was diagnosed with Clostridium difficileinfection (0 vs 1). Administration of pantoprazole was not associated with any difference in rates of overt bleeding (6 vs 3; p = 0.50) or daily hemoglobin concentrations when adjusted for transfusion rates of packed red cells (p = 0.66). Mortality was similar between groups (log-rank p = 0.33: adjusted hazard ratio for pantoprazole: 1.68 [95% CI, 0.97-2.90]; p = 0.06). CONCLUSIONS: We found no evidence of benefit or harm with the prophylactic administration of pantoprazole to mechanically ventilated critically illpatients anticipated to receive enteral nutrition. The practice of routine administration of acid-suppressive drugs to critically illpatients for stress ulcer prophylaxis warrants further evaluation.
Authors: Massimo Antonelli; Ignacio Martin-Loeches; George Dimopoulos; Antonio Gasbarrini; Maria Sole Vallecoccia Journal: Intensive Care Med Date: 2020-01-14 Impact factor: 17.440
Authors: Marija Barbateskovic; Søren Marker; Anders Granholm; Carl Thomas Anthon; Mette Krag; Janus Christian Jakobsen; Anders Perner; Jørn Wetterslev; Morten Hylander Møller Journal: Intensive Care Med Date: 2019-01-24 Impact factor: 17.440