PEPTIC Trial Summary: PPI vs. H2 blockers for Stress Ulcers in Intubated Patients

PEPTIC Trial stress ulcers PPI H2 blockers

2020 PEPTIC TRIAL 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 Pragmatic, open-label, cluster randomised crossover design trial Objective: To compare in-hospital mortality rates using PPIs vs Histamine-2 receptor blockers (H2RBs) for stress ulcer prophylaxis. 26828 Inclusion criteria: Participants 18 years of age requiring invasive mechanical ventilation within 24 hours of ICU admission & those with diagnosis of upper gastrointestinal bleeding were excluded. patients PPl group (n=13436) H2RB group (n=13392) PRIMARY OUTCOME 18.3 90 day in-hospital mortality % RR 1.05; 95% CI, 1.00 to 1.10; P=0.054 17.5 SECONDARY OUTCOME upper GI bleeding % 1.3 1.8 RR 0.73; 95% CI, 0.57 to 0.92; P=0.009 0.3 Clostridium difficile infection % RR 0.74; 95% CI, 0.51 to 1.09; P=0.13 0.43 Conclusion: Among ICU patients requiring mechanical ventilation, a strategy of stress ulcer prophylaxis with use of proton pump inhibitors vs histamine-2 receptor blockers resulted in hospital mortality rates of 18.3% vs 17.5%, respectively, a difference that did not reach the significance threshold. P Young et al. JAMA. 2020;323(7):616-626