![]() The Observational Medical Outcomes Partnership (OMOP) common data model (CDM) is a logical and semantic information model for health care data that can translate diverse data sources into a standardized format 23, 24. Considering that over half of the patients in the ICU are prescribed drugs for SUP, further research to answer this uncertainty is essential 22. In the most recently published network meta-analysis, the evidence for the effects of PPIs and H2RAs on the mortality rate and GI bleeding lacked robustness 21. Several randomized controlled trials (RCTs) have been conducted to compare PPIs and H2RAs for SUP 15, 16, 17, 18, 19, 20. However, the preferred agents vary among guidelines 12, 13, 14. The current guidelines for SUP in the ICU recommend the use of either PPI or H2RA for patients who have risk factors for GI bleeding 12, 13, 14. Nonetheless, concerns about adverse events associated with these drugs, including pneumonia and Clostridioides difficile infection, have been raised, with some studies suggesting that these risks peak shortly after starting the drugs, which is the case of most patients in the ICU 6, 7, 8, 9, 10, 11. Stress ulcer prophylaxis (SUP) using either type of drug reduces the risk of clinically important GI bleeding. Proton pump inhibitors (PPIs) are the most commonly used drugs in intensive care units (ICUs) to prevent GI bleeding caused by stress ulcers, followed by histamine 2 receptor antagonists (H2RAs) 5. The pathophysiology of stress ulcers in critically ill patients is not fully understood however, they are believed to be related to the disruption of mucosal protective defenses against gastric acid, gastric mucosal hypoperfusion, increased acid production, and oxidative injury to the digestive tract 4. ![]() These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.Ĭritically ill patients are at risk of stress ulcer-related gastrointestinal tract (GI) bleeding which is known to affect between 2.6 and 6.6% of these patients, being associated with 2- to 4-times higher risk of death 1, 2, 3. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28 P = 0.01). After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. ![]() Proton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. ![]()
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