{"id":18256,"date":"2020-02-02T05:00:11","date_gmt":"2020-02-01T21:00:11","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18256"},"modified":"2020-02-28T06:12:28","modified_gmt":"2020-02-27T22:12:28","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9appi%e4%b8%8eh2%e5%8f%97%e4%bd%93%e4%bd%93%e9%98%bb%e6%bb%9e%e5%89%82%e8%bf%9b%e8%a1%8c%e5%ba%94%e6%bf%80%e6%80%a7%e6%ba%83%e7%96%a1%e9%a2%84%e9%98%b2","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18256","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1aPPI\u4e0eH2\u53d7\u4f53\u4f53\u963b\u6ede\u5242\u8fdb\u884c\u5e94\u6fc0\u6027\u6e83\u75a1\u9884\u9632\u5bf9\u63a5\u53d7\u6709\u521b\u673a\u68b0\u901a\u6c14\u60a3\u8005\u4f4f\u9662\u75c5\u6b7b\u7387\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation\u00a0|Caring for the Critically Ill Patient | January\u00a017,\u00a02020<\/p>\n\n\n\n

Effect of Stress Ulcer Prophylaxis With Proton Pump Inhibitors vs Histamine-2 Receptor Blockers on In-Hospital Mortality Among ICU Patients Receiving Invasive Mechanical Ventilation: The PEPTIC Randomized Clinical Trial<\/h1>\n\n\n\n

The PEPTIC Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group, Alberta Health Services Critical Care Strategic Clinical Network, and the Irish Critical Care Trials Group<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online January 17, 2020. doi:10.1001\/jama.2019.22190<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Importance<\/strong>\u00a0<\/h3>\n\n\n\n

Proton pump inhibitors (PPIs) or histamine-2 receptor blockers (H2<\/sub>RBs) are often prescribed for patients as stress ulcer prophylaxis drugs in the intensive care unit (ICU). The comparative effect of these drugs on mortality is unknown.<\/p>\n\n\n\n

Objective<\/strong>\u00a0<\/h3>\n\n\n\n

To compare in-hospital mortality rates using PPIs vs H2<\/sub>RBs for stress ulcer prophylaxis.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>\u00a0<\/h3>\n\n\n\n

Cluster crossover randomized clinical trial conducted at 50 ICUs in 5 countries between August 2016 and January 2019. Patients requiring invasive mechanical ventilation within 24 hours of ICU admission were followed up for 90 days at the hospital.<\/p>\n\n\n\n

Interventions<\/strong>\u00a0<\/h3>\n\n\n\n

Two stress ulcer prophylaxis strategies were compared (preferential use with PPIs vs preferential use with H2<\/sub>RBs). Each ICU used each strategy sequentially for 6 months in random order; 25 ICUs were randomized to the sequence with use of PPIs and then use of H2<\/sub>RBs and 25 ICUs were randomized to the sequence with use of H2<\/sub>RBs and then use of PPIs (13\u202f436 patients randomized by site to PPIs and 13\u202f392 randomized by site to H2<\/sub>RBs).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>\u00a0<\/h3>\n\n\n\n

The primary outcome was all-cause mortality within 90 days during index hospitalization. Secondary outcomes were clinically important upper gastrointestinal bleeding,\u00a0Clostridioides difficile<\/em>\u00a0infection, and ICU and hospital lengths of stay.<\/p>\n\n\n\n

Results<\/strong>\u00a0<\/h3>\n\n\n\n

Among 26\u202f982 patients who were randomized, 154 opted out, and 26\u202f828 were analyzed (mean [SD] age, 58 [17.0] years; 9691 [36.1%] were women). There were 26\u202f771 patients (99.2%) included in the mortality analysis; 2459 of 13\u202f415 patients (18.3%) in the PPI group died at the hospital by day 90 and 2333 of 13\u202f356 patients (17.5%) in the H2<\/sub>RB group died at the hospital by day 90 (risk ratio, 1.05 [95% CI, 1.00 to 1.10]; absolute risk difference, 0.93 percentage points [95% CI, \u22120.01 to 1.88] percentage points;\u00a0P<\/em>\u2009=\u2009.054). An estimated 4.1% of patients randomized by ICU site to PPIs actually received H2<\/sub>RBs and an estimated 20.1% of patients randomized by ICU site to H2<\/sub>RBs actually received PPIs. Clinically important upper gastrointestinal bleeding occurred in 1.3% of the PPI group and 1.8% of the H2<\/sub>RB group (risk ratio, 0.73 [95% CI, 0.57 to 0.92]; absolute risk difference, \u22120.51 percentage points [95% CI, \u22120.90 to \u22120.12 percentage points];\u00a0P<\/em>\u2009=\u2009.009). Rates of\u00a0Clostridioides difficile<\/em>\u00a0infection and ICU and hospital lengths of stay were not significantly different by treatment group. One adverse event (an allergic reaction) was reported in 1 patient in the PPI group.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>\u00a0<\/h3>\n\n\n\n

Among ICU patients requiring mechanical ventilation, a strategy of stress ulcer prophylaxis with use of proton pump inhibitors vs histamine-2 receptor blockers resulted in hospital mortality rates of 18.3% vs 17.5%, respectively, a difference that did not reach the significance threshold. However, study interpretation may be limited by crossover in the use of the assigned medication.<\/p>\n\n\n\n

Trial Registration<\/strong>\u00a0<\/h3>\n\n\n\n

anzctr.org.au Identifier:\u00a0ACTRN12616000481471<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation\u00a0|Caring for the Critically Ill P […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18256"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18256"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18256\/revisions"}],"predecessor-version":[{"id":18257,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18256\/revisions\/18257"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18256"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18256"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18256"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}