Core IM | Internal Medicine Podcast #166 Stress Ulcer Prophylaxis in the ICU and REVISE Trial: Beyond Journal Club with NEJM Group
35 snips
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!
AI Snips
Chapters
Transcript
Episode notes
Stress Ulcer Bleeding: Prevalence vs. Severity
- Stress ulcers are common in ICU patients, but clinically important bleeding is rare (under 2%).
- Mortality from stress ulcer bleeding is high (up to 50%) for those who experience it.
Evolution of Stress Ulcer Prophylaxis
- Early studies from the 70s used liquid antacids and pH monitoring to prevent stress ulcers.
- H2 blockers like ranitidine proved more effective than sucralfate in later studies.
SUP-ICU Trial and PPI Concerns
- The SUP-ICU trial (2018) compared PPIs to placebo, finding no mortality difference but a potential bleeding reduction.
- Concerns arose regarding PPI-associated pneumonia and C. diff infections, despite observational evidence.