This site is intended for Healthcare professionals only.

Prophylactic pantoprazole in ICU offers no mortality benefit


Prophylactic pantoprazole in ICU offers no mortality benefit

A new study published in NEJM reports that no significant differences were found between pantoprazole and placebo with regard to either 90-day mortality or the number of clinically important events among adult patients in the ICU who were at risk for gastrointestinal bleeding.

Critically ill patients in the intensive care unit (ICU) are at risk for stress-related gastrointestinal bleeding, which is associated with adverse outcomes. Patients in the ICU frequently receive prophylaxis for gastrointestinal stress ulceration but its risks and benefits are not certain. The quality of evidence supporting the prophylactic use of proton-pump inhibitors in the ICU is limited.

Read Also: PPIs use in infancy for reflux Increases childhood fracture risk
Mette Krag et al. conducted a multicentered, parallel-group, blinded trial to evaluate the effects of adverse events associated with the prophylactic use of the proton-pump inhibitor pantoprazole in adult patients in the ICU who were at risk for gastrointestinal bleeding.

The study included 3298 patients out of which 1645 were randomly assigned to 40 mg of intravenous pantoprazole (a proton-pump inhibitor) group and 1653 to the placebo group.

The key study findings included are:

  • At 90 days, 510 patients (31.1%) in the pantoprazole group and 499 (30.4%) in the placebo group had died.
  • During the ICU stay, at least one clinically important event (a composite of clinically important gastrointestinal bleeding, pneumonia, Clostridium difficileinfection, or myocardial ischemia) had occurred in 21.9% of patients assigned to pantoprazole and 22.6% of those assigned to placebo.
  • In the pantoprazole group, 2.5% of patients had clinically important gastrointestinal bleeding, as compared with 4.2% in the placebo group.
  • The number of patients with infections or serious adverse reactions and the percentage of days alive without life support within 90 days was similar in the two groups.

Read Also: Fixed-dose amitriptyline plus pantoprazole effective in GERD with anxiety

“In this trial involving adult patients who were admitted to the ICU for an acute condition and were at risk for gastrointestinal bleeding, we found no significant differences between pantoprazole and placebo with regard to either 90-day mortality or the number of patients with a composite outcome of four clinically important events,” write the authors.

For reference log on to https://www.nejm.org/doi/full/10.1056/NEJMoa1714919

The following two tabs change content below.
Vinay Singh

Vinay Singh

Vinay Singh joined Medical Dialogue as Desk Editor in 2018. He covers the medical speciality news in different medical categories including Medical guidelines, updates from Medical Journals and Case Reports. He completed his graduation in Biotechnology from AAIDU and did his MBA from IILM Gurgaon. He can be contacted at editorial@medicaldialogues.in . Contact no. 011-43720751
Source: With inputs from NEJM

Share your Opinion Disclaimer

Sort by: Newest | Oldest | Most Voted