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

Abstract

Data collected during 2013 and 2014 indicated an estimated 2.5% of adults acutely admitted to an intensive care unit (ICU) developed upper gastrointestinal bleeding and, in an attempt to prevent this bleeding, 70% were prescribed stress ulcer prophylaxis.¹ Although proton pump inhibitors reportedly reduced bleeding risk,^2,3 and were prescribed most commonly according to data collected during 2014, some clinicians prescribed histamine-2 receptor blockers.^4,5 This practice variation depended on clinician preference or hospital policy.^3,5 A meta-analysis⁶ of randomized clinical trials concluded that proton pump inhibitors might be more effective than histamine-2 receptor blockers in preventing upper gastrointestinal bleeding; however, the robustness of this conclusion was limited by the paucity of available data, the methodological limitations of the trials included, and possible publication bias.