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