Tuesday, October 30, 2018


PulmCrit (EMCrit)
PulmCrit - October 30, 2018 - By Josh Farkas 
"Summary: The Bullet
  • Stress ulceration doesn’t significantly affect mortality. Therefore, there is no way that preventing stress ulceration could possibly improve mortality. The fact that SUP-ICU detected no mortality benefit was inevitable and doesn’t provide any new information about SUP. DVT prophylaxis doesn’t affect mortality either.
  • Pantoprazole did its job in this trial: it reduced the incidence of stress ulceration (by 50%) without any detectable toxicity (no increase in clostridium difficile or pneumonia rates). Lack of toxicity may favor use of pantoprazole as a front-line agent for SUP.
  • Pantoprazole reduced the incidence of clinically important GI bleeding by 1.7%, yielding a number needed to treat (NNT) of 59. This suggests that SUP should be restricted to a more highly selected population of patients, who are at greater risk of stress ulceration.
  • Further work is needed to define which patients may benefit from SUP. There is probably a role for it, but we’re using it too often."