Paul Marik, who has appeared in a few posts on rpaicu.com, gives us another possible game-changer with this meta-analysis on stress ulcer prophylaxis. He found that H2 receptor blockers prevent stress ulcer related bleeding, but only in the subgroup of patients who were not being enterally fed. Stress ulcer prophylaxis had no additional effect in patients receiving enteral nutrition, even if it was inadequate (i.e. not at target rate). Furthermore, in patients who were being fed enterally and received an H2 receptor blocker, the incidence of VAP was increased.
He argues that once your patient is fed, even if you haven’t reached the target rate, you should stop the stress ulcer prophylaxis.
This paper was presented to the CICM ICU Update this year by Prof. Marianne Chapman, who informed the audience that this is now the practice at the RAH…maybe we should follow suit at RPA?
Now, I know we use PPIs rather than H2RBs, but most trials find these agents to be equivalent..
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