R.E.B.E.L.EM - February 24, 2020 - By Zaf Qasim
"Clinical Take Home Point:
- This is a good attempt at trying to answer a clinically-relevant question for intensivists (and ED physicians who are having to manage ICU boarders for a longer period of time). The authors attempted to achieve statistical power through a huge number of included patients, and generalizability by recruiting across many nations in multiple ICUs. Ultimately, the interpretation of the data was limited due to the nonadherence to the study protocol and the use of registry data for their analysis.
- Even though there may be lower rates of gastrointestinal bleeding in the PPI group, there is no statistically significant reason in terms of mortality to use PPI over H2RB (and there may in fact be some more harm in using PPIs).
- For the time being, we should continue to use H2RBs as the primary agent for stress ulcer prophylaxis in mechanically ventilated ICU patients."