Rational use of acute gastric mucosal injury prophylaxis in intensive care unit without compromising patient safety: a cohort study

Background Acute gastric mucosal injury poses a significant risk of gastrointestinal bleeding in intensive care unit patients. Prophylaxis is frequently applied but its indiscriminate use may cause adverse effects. Objective: To evaluate the effectiveness and safety of a rational prophylaxis protocol for acute gastric mucosal lesions in critically ill patients based on clinical risk criteria. Methods: Retrospective observational study with a comparative analysis between two periods: cohort 1 (January to December 2021), before the protocol implementation, and cohort 2 (January to December 2022), after adopting the protocol based on the criteria proposed by Ye et al. (2020). The outcomes analyzed were the use of proton pump inhibitors (PPIs), upper gastrointestinal bleeding (UGIB), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection. Results: A total of 1,614 patients were included, 641 in the pre-exposure group and 973 in the post-exposure group. There was no difference in age, sex, disease severity, previous comorbidities, or use of intensive therapies between groups. The results indicated a significant reduction in proton pump inhibitors use, from 51% in the pre-exposure group to 40% in the post-exposure group (P < 0.001). Furthermore, no significant differences were observed between groups for diagnostic outcomes of gastrointestinal bleeding, respiratory complications, healthcare-associated infections, duration of mechanical ventilation, length of hospital stay, or mortality. Conclusion: The protocol for the rational use of proton pump inhibitors was effective in reducing the use of these drugs without compromising the safety and clinical outcomes of intensive care unit patients. These results must be confirmed by randomized control trials.