#166 Stress Ulcer Prophylaxis in the ICU and REVISE Trial: Beyond Journal Club with NEJM Group

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 11 December 2024

⏱️ 35 minutes

🔗️ Recording | iTunes | RSS

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Summary

What’s the evidence been for the use of PPIs in mechanically ventilated patients? What do more recent studies reveal about PPIs and possible harmful side effects of aspiration pneumonia and C. difficile colitis? To find out, tune into the second season of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

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Timestamps:

(02:13) | Define the problem / Clinically important bleeding Outcome/Risk benefit /Risk factors]

(05:58) | Hx and H2 antagonists

(10:42) | SUP-ICU

(15:12) | PEPTIC

(19:30) | REVISE trial

(27:28) | Deprescribing

(29:06) | Outstanding questions

Transcript and Show Notes

Tags: CoreIM, InternalMedicine, CriticalCare, Proton Pump Inhibitors, GIbleeding, ICU, ICU bleeding, Clinical Trials, Evidence Based Medicine, Patient Centered Outcomes, Deprescribing

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Transcript

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0:00.0	Welcome to Beyond Journal Club, a collaboration between Coriam and N.E.J.M. Group. The goal of Beyond Journal Club is to take landmark clinical trials and put them into context. We're telling the story about how we got to where we are, what it means for our patients and how we take care. I'm Dr. Greg Katz, cardiologist in NYU. And I'm Dr. Sarah Gori, an editorial fellow at the New England
0:23.1	Journal of Medicine. And this may be the first time we have a friend from overseas and from the
0:28.0	wonderful great land of Ireland. Well, I'm really honored to be the first and hopefully not the last.
0:33.9	Oh yeah, it's awesome. I feel way more sophisticated when I talk to you and I probably is a psychological thing, but I'm excited.
0:40.9	Okay, so today we are talking about the revised trial, which was published in the July 4th issue of the New England Journal of Medicine in 2024.
0:48.8	All right. And so put it out there. What did the revised trial ask?
0:52.1	Revise asks the question, do proton pump inhibitors, aka
0:55.7	PPI, prevent stress ulcers? And do they do that without causing harm in intubated ICU patients?
1:03.2	My first thought when I was considering this trial was how many of us just get a prompt that we should
1:07.8	be ordering stress ulcer prophylaxis and then we click sign in the EMR. And it makes me cynical to see how sometimes the evidence behind our most common practices
1:15.9	isn't always all that strong. And so I think revised is really interesting because it helps us dive
1:20.8	into whether PPI prophylaxis is like too many other things that we do in medicine, built on a
1:25.6	house of cards worth of flimsy evidence.
1:32.0	Yeah. Oh, I love that image rate. I feel like that cover art of like flimsy cards,
1:36.5	this should be like the cover art of the house of God or many of the books written about medicine and general. I know you had a cynical bone in your body, so that's interesting to say.
1:40.0	Sometimes I am a real EOR. But anyways, let's go back to the more positive side of things.
1:46.7	Sarah, what are we covering today?
1:48.2	So before we dive into the story behind this trial, let's just review exactly what a stress
1:53.3	ulcer is and make sure we're totally clear about what type of patients are at risk.
1:58.1	Yeah, and then we're going to discuss the story of acid blockade and what the evidence has actually
2:02.1	showed in terms of PPI's in the first place.
2:04.6	And finally, we'll discuss how the revised trial can impact our patient care, particularly
	...

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