ANZICS CTG Endorsed Study
The Re-EValuating the Inhibition of Stress Erosions (REVISE) trial
There is currently inadequate evidence to support the widespread practice of stress ulcer prophylaxis through the daily administration of pantoprazole. Following the recent publication of SUPICU trial results (Krag, M. N Engl J Med 2018, 379: 2199-2208), current data indicate that despite the increase in proton pump inhibitor administration the question of whether ICU patients should receive pantoprazole remains.
There are theoretical reasons and existing data which suggest the use of proton pump inhibitors may increase the risk of ventilator-associated pneumonia, which is estimated to carry an attributable mortality of at least 6% and to increase hospital length of stay by approximately 6 days, and Clostridium difficile infection. Accordingly, a definitive methodologically rigorous study is needed to establish whether routine proton pump inhibitor administration results in net benefit or harm. Furthermore, a subgroup analysis of the trial by Krag et al. suggested an increased risk of death in the most seriously ill patients receiving pantoprazole, which remains unexplained.
Adam Deane (Co-Chair), Simon Finfer (Co-Chair), Marianne Chapman, Naomi Hammond, Miranda Hardie (Project Manager), Serena Knowles, John Myburgh, Alexis Poole, Dorrilyn Rajbhandari, Bala Venkatesh, Paul Young and Laurent Billot (Biostatistician).
The George Institute for Global Health
NHMRC, Canadian Institute of Health Research, Canadian Institutes for Health Research, Accelerated Clinical Trials Platform