Pantoprazole reduces GI bleeding risk in ventilated ICU patients

Global trial results provide clarity on proton-pump inhibitor use

A large international trial and updated systematic review have provided critical evidence supporting the use of the proton-pump inhibitor pantoprazole to prevent upper gastrointestinal (GI) bleeding in critically ill adults requiring mechanical ventilation.


REVISE trial shows pantoprazole lowers clinically significant GI bleeding

The Reevaluating the Inhibition of Stress Erosions (REVISE) Trial, a global randomized controlled trial across 68 centres in 8 countries, investigated the effects of pantoprazole versus placebo in over 4,800 invasively ventilated ICU patients. The pantoprazole group experienced a significantly lower risk of clinically important upper GI bleeding (1%) compared to the placebo group (3.5%). However, there was no significant difference in 90-day mortality between the two groups.

microscopic view of large intestine

To synthesize the current evidence, researchers conducted a meta-analysis of 12 randomized trials evaluating proton-pump inhibitors for GI bleeding prophylaxis in 10,000 critically ill patients. The analysis confirmed a reduced incidence of clinically significant upper GI bleeding with these medications, with little to no effect on mortality, pneumonia risk, or Clostridioides difficile infection rates.

“This is the largest trial on this topic globally, led by Canadian researchers,” said principal investigator Dr Deborah Cook of McMaster University. “Physicians, nurses, and pharmacists working in the ICU setting will use this information in practice right away, and the trial results and the updated meta-analysis will be incorporated into international practice guidelines.”

The study results, published June 14, 2024 in The New England Journal of Medicine < doi: >  and NEJM Evidence, were funded by Canadian, Australian and Ontario medical research agencies.