Withholding Pantoprazole for Stress Ulcer Prophylaxis in Critically Ill Patients: A Pilot Randomized Clinical Trial and Meta-Analysis
Waleed Alhazzani, Gordon Guyatt, Mohammed Alshahrani, Adam M Deane, John C Marshall, Richard Hall, John Muscedere, Shane W English, Francois Lauzier, Lehana Thabane, Yaseen M Arabi, Tim Karachi, Bram Rochwerg, Simon Finfer, Nick Daneman, Fayez Alshamsi, Nicole Zytaruk, Diane Heel-Ansdell, Deborah Cook
Critical Care Medicine | LIPPINCOTT WILLIAMS & WILKINS | Published : 2017
INTRODUCTION: A decreased frequency of upper gastrointestinal bleeding and a possible association of proton pump inhibitor use with Clostridium difficile and ventilator-associated pneumonia have raised concerns recently. The Reevaluating the Inhibition of Stress Erosions Pilot Trial determined the feasibility of undertaking a larger trial investigating the efficacy and safety of withholding proton pump inhibitors in critically ill patients. METHODS: In 10 ICUs, we randomized adult ICU patients anticipated to be mechanically ventilated for greater than or equal to 48 hours to receive 40 mg of IV pantoprazole daily or placebo. We excluded patients who had acute or recent gastrointestinal bleed..View full abstract
REVISE Pilot Trial was supported, in part, by Research Grants awarded by Physicians Services Incorporated of Ontario, Dammam University Research Funds, Capital Health Authority Research in Halifax, and the Royal Adelaide Hospital Project Committee.Dr. Alhazzani holds a McMaster University Department of Medicine Internal Career Research Award. Dr. Guyatt's institution received funding from Physicians Services Incorporated. Dr. Alshahrani's institution received funding from University of Dammam deanship of research. Dr. Deane's institution received funding from the Royal Adelaide Hospital Research Fund. Dr. Marshall received funding from Regeneron, AKPA Pharma, and Bristol-Myers Squibb. Dr. Hall's institution received funding from La Jolla, E-Motion, Sunnybrook Medical Centre (Canadian Institutes of Health Research [CIHR] grant), McMaster University (CIHR grant), Queens University (CIHR grant), and he disclosed funding from Trius Therapeutics, Asahi Kasei Pharma, Leading Biosciences, Capital Health Research Fund, GlaxoSmithKline, Portola, and Pfizer. Dr. English's institution received funding from the sponsoring centre and from La Jolla Pharmaceuticals for the Athos 3 trial. Dr. Lauzier is a recipient of a research career award from the Fonds de la recherche du Quebec-Sante. Dr. Finfer's institution received funding from Baxter Healthcare and Regeneron. Ms. Heel-Ansdell's institution received funding from PSI Foundation Grant. Dr. Cook's institution received funding from Physicians Services Incorporated of Ontario. She is a Canada Research Chair of the Canadian Institutes for Health Research. The remaining authors have disclosed that they do not have any potential conflicts of interest.