The hosts discuss the CCR24 conference, stress ulcer prophylaxis in ventilated patients, conflicting data in critical care, comparison of pre-oxygenation methods, sedation options, ivermectin use for COVID-19, steroids for pneumonia, and upcoming presentations on various treatment options in critical care.
43:50
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Quick takeaways
The REVISE trial highlights the importance of PPIs in reducing upper GI bleeds in mechanically ventilated patients.
Future trials may investigate differences in outcomes between H2 blockers and PPIs for stress ulcer prophylaxis.
Deep dives
Overview of the Podcast Episode
The podcast episode dissects the Revise trial, focusing on stress ulcer prophylaxis in mechanically ventilated patients. It delves into the study design and outcomes, including clinically important upper GI bleeds and 90-day mortality. The discussion highlights key findings, such as the lower incidence of GI bleeds in the Pantoprazole group compared to the placebo group.
Importance of PPIs in Enteral Nutrition Patients
The study reaffirms the benefit of PPIs in patients receiving enteral nutrition, as evidenced by a reduction in clinically important GI bleeds. This underlines the importance of PPIs in this patient population and supports their continued use for stress ulcer prophylaxis.
Comparison with Meta-analysis Findings
The podcast episode also touches on a meta-analysis that aligns with the trial's results regarding PPIs and mortality. It suggests that while PPIs may not impact mortality significantly, they could have differing effects based on the severity of illness, warranting further investigation.
Consideration for Future Research
The discussion raises the question of future trials comparing H2 blockers versus PPIs to determine if there are differences in outcomes between the two types of acid suppressants. While the current trial provides valuable insights, there may still be merit in exploring this comparison in clinical practice.
Episode 41! We continue our CCR24 recap with a brief overview and thoughts on the conference as a whole and then dive into REVISE or "Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation" published by Cook et al in NEJM June 2024. Not the sexiest of all the topics but important nonetheless (and we will get to the others soon!)
REVISE: https://pubmed.ncbi.nlm.nih.gov/38875111/
If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!
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