6/29/23, 1:37 AM PEPTIC Pathway Feedback Search Clinical Topics Home Studies PEPTIC PEPTIC DiseasePeptic ulcer disease Trial question What is the effect of proton pump inhibitors for stress ulcer prophylaxis among ICU patients receiving invasive mechanical ventilation? Study design Multi-center Open label RCT Population Characteristics of study participants 36.0% female N = 26982 64.0% male 26982 patients (9691 female, 17137 male) Inclusion criteria: patients requiring invasive mechanical ventilation within 24 hours of ICU admission Key exclusion criteria: ICU admission diagnosis of upper gastrointestinal bleeding, previous ICU admission Interventions N=13436 proton pump inhibitors (esomeprazole, pantoprazole, lansoprazole, omeprazole, rabeprazole, through all routes) N=13392 histamine-2 receptor blockers (ranitidine intravenous or enteral) https://web.pathway.md/studies/recgbW9JiBMhoko8d 1/2 6/29/23, 1:38 AM PEPTIC Pathway Primary outcome Rate of death in the hospital by day 90 18.3 % 18.3 17.5 13.7 % 9.2 % 4.6 % Borderline significant increase 0.0 % Proton pump inhibitors Histamine-2 receptor blockers Borderline significant increase in the rate of death in the hospital by day 90 (18.3% vs. 17.5%; RR 1.05, 95% CI 1 to 1.1) Secondary outcomes Significant decrease in clinically important upper gastrointestinal bleeding (1.3% vs. 1.8%; RR 0.73, 95% CI 0.57 to 0.92) No significant difference in C. difficile infection (0.3% vs. 0.43%; RR 0.74, 95% CI 0.51 to 1.09) No significant difference in hospital length of stay (12.2 days vs. 12 days; ROM 1.01, 95% CI 0.98 to 1.03) Safety outcomes No significant difference in allergic reactions or clinically important upper gastrointestinal bleeding. Conclusion In patients requiring invasive mechanical ventilation within 24 hours of ICU admission, proton pump inhibitors were inferior to histamine-2 receptor blockers with respect to the rate of death in the hospital by day 90. Reference 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 et al. 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. JAMA. 2020 Feb 18;323(7):616-626. Open reference URL https://web.pathway.md/studies/recgbW9JiBMhoko8d 2/2