Pantoprazole for stress ulcer prophylaxis in intensive care

The Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) study, published in the New England Journal of Medicine, evaluated the use of prophylactic pantoprazole in patients at risk of gastrointestinal bleeding (GIB) in ICU.1 Interestingly, despite being one of the most commonly used off-licence drugs in ICU, proton pump inhibitors are not Food and Drug Administration (FDA) approved for stress ulcer prophylaxis. In 33 ICUs across Europe, adult patients felt to be at risk of GIB, which included patients with shock, use of anticoagulant agents, renal replacement therapy, mechanical ventilation, history of liver disease or ongoing coagulopathy, were randomised to receive pantoprazole 40 mg versus placebo for stress ulcer prophylaxis (1640 vs 1642). Primary outcome was death within 90 days after randomisation. Secondary outcomes were clinically important events in the ICU defined as clinically important GIB, new-onset pneumonia, Clostridium difficile infection or acute myocardial ischaemia.

In total, 510 of 1642 patients (31.1%) in the pantoprazole group and 499 of 1640 (30.4%) in the placebo group had died (relative risk, 1.02; 95% CI 0.91 to 1.13; p=0.76). A total of 360 (21.9%) …