Withholding Stress Ulcer Prophylaxis To Mechanically Ventilated Enterally-Fed Critically Ill Patients Appears Safe: A Randomised Double-Blind Placebo Controlled Pilot Study

Methods This prospective randomised double-blind study was performed over a 12-month period. All critically ill patients who were anticipated to be ventilated for greater than 24 hours and enterally fed within 48 hours were eligible. Patients receiving acid-suppressing medication prior to admission and those admitted with GI bleeding were excluded. Patients were assigned to receive IV pantoprazole or placebo daily until no longer mechanically ventilated, or for a maximum of 14 days. Data were collected for overt GI bleeding (haematemesis, blood-stained gastric aspirate, melaena or haematochezia), clinically significant bleeding (overt bleeding accompanied by a reduction in mean arterial pressure >20mmHg in the absence of another cause, or reduction in haemoglobin >20g/L, or need for endoscopy/surgical intervention) and C. difficile infection. Patients were tested for C. difficile if they had diarrhoea (defined as ≥3 bowel movements in 24 hours) or a temperature of ≥38.6°C and white cell count ≥20 × 10/mL. Data are mean ± SD or median (IQR) and compared using chi-squared tests or MannWhitney U tests as appropriate.