Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation.
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История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Cook Deborah, Deane Adam, Lauzier François, Zytaruk Nicole, Guyatt Gordon, Saunders Lois, Hardie Miranda, Heels-Ansdell Diane, Alhazzani Waleed, Marshall John, Muscedere John, Myburgh John, English Shane, Arabi Yaseen M, Ostermann Marlies, Knowles Serena, Hammond Naomi, Byrne Kathleen M, Chapman Marianne, Venkatesh Balasubramanian, Young Paul, Rajbhandari Dorrilyn, Poole Alexis, Al-Fares Abdulrahman, Reis Gilmar, Johnson Daniel, Iqbal Mobeen, Hall Richard, Meade Maureen, Hand Lori, Duan Erick, Clarke France, Dionne Joanna C, Tsang Jennifer L Y, Rochwerg Bram, Karachi Timothy, Lamontagne Francois, D'Aragon Frédérick, St Arnaud Charles, Reeve Brenda, Geagea Anna, Niven Daniel, Vazquez-Grande Gloria, Zarychanski Ryan, Ovakim Daniel, Wood Gordon, Burns Karen E A, Goffi Alberto, Wilcox M Elizabeth, Henderson William, Forrest David, Fowler Rob, Adhikari Neill K J, Ball Ian, Mele Tina, Binnie Alexandra, Trop Sebastien, Mehta Sangeeta, Morgan Ingrid, Loubani Osama, Vanstone Meredith, Fiest Kirsten, Charbonney Emmanuel, Cavayas Yiorgos A, Archambault Patrick, Rewa Oleksa G, Lau Vincent, Kristof Arnold S, Khwaja Kosar, Williamson David, Kanji Salmaan, Sy Eric, Dennis Brittany, Reynolds Steve, Marquis Francois, Lellouche François, Rahman Adam, Hosek Paul, Barletta Jeffrey F, Cirrone Robert, Tutschka Mark, Xie Feng, Billot Laurent, Thabane Lehana, Finfer Simon, REVISE Investigators
Аннотация
METHODS: In this international, randomized trial, we assigned critically ill adults who were undergoing invasive ventilation to receive intravenous pantoprazole (at a dose of 40 mg daily) or matching placebo. The primary efficacy outcome was clinically important upper gastrointestinal bleeding in the intensive care unit (ICU) at 90 days, and the primary safety outcome was death from any cause at 90 days. Multiplicity-adjusted secondary outcomes included ventilator-associated pneumonia, Clostridioides difficile infection, and patient-important bleeding.
RESULTS: A total of 4821 patients underwent randomization in 68 ICUs. Clinically important upper gastrointestinal bleeding occurred in 25 of 2385 patients (1.0%) receiving pantoprazole and in 84 of 2377 patients (3.5%) receiving placebo (hazard ratio, 0.30; 95% confidence interval [CI], 0.19 to 0.47; P<0.001). At 90 days, death was reported in 696 of 2390 patients (29.1%) in the pantoprazole group and in 734 of 2379 patients (30.9%) in the placebo group (hazard ratio, 0.94; 95% CI, 0.85 to 1.04; P = 0.25). Patient-important bleeding was reduced with pantoprazole; all other secondary outcomes were similar in the two groups.
CONCLUSIONS: Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo, with no significant effect on mortality. (Funded by the Canadian Institutes of Health Research and others; REVISE ClinicalTrials.gov number, NCT03374800.).