Core IM | Internal Medicine Podcast
#166 Stress Ulcer Prophylaxis in the ICU and REVISE Trial: Beyond Journal Club with NEJM Group
Dec 11, 2024
Discover the latest research on stress ulcer prophylaxis in ICU patients, focusing on proton pump inhibitors (PPIs) and their potential risks like aspiration pneumonia. Dive into the REVISE trial findings and understand the complexities surrounding the use of PPIs in critically ill patients. The discussion also tackles the evolution of treatments, addressing the need for high-quality evidence to guide practices while highlighting the importance of patient-centered outcomes. Plus, enjoy some engaging banter to lighten the mood!
32:16
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Quick takeaways
- The REVISE trial reveals that while PPIs effectively reduce clinically important GI bleeding in ICU patients, their long-term use requires careful reevaluation to avoid unnecessary prescriptions.
- Emphasizing patient-centered outcomes, the trial demonstrates that PPIs significantly reduce adverse events impacting patient recovery, advocating for a healthcare shift towards prioritizing patient experiences.
Deep dives
The Role of PPIs in Preventing Stress Ulcers
Proton pump inhibitors (PPIs) are commonly used to prevent stress ulcers in intubated ICU patients, as they effectively reduce gastric acidity. The revised trial aimed to assess their efficacy and safety, questioning whether they prevent clinically important gastrointestinal (GI) bleeding without causing harm. It highlighted a concerning lack of robust evidence supporting the routine practice of prescribing PPIs, especially considering that many prior trials had provided only limited support. The trial ultimately found that PPIs significantly decreased the rates of clinically important bleeding compared to placebo, marking them as effective in this high-risk population.
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