Critically evaluate the role of proton pump inhibitors to prevent upper gastrointestinal bleeding in ICU patients using the following headings in your answer:
a) Rationale (30% marks)
b) Disadvantages (20% marks)
c) Evidence (30% marks)
d) My clinical practice (20% marks)
This SAQ is very similar to Question 11 from the first paper of 2020, and the answer from 2020 is mostly reproduced below, with only a couple of changes to adjust to the fact that now the marking criteria and the expected structure are much better explained
My clinical practice:
Krag, Mette, et al. "Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU." New England Journal of Medicine 379.23 (2018): 2199-2208.
Young, Paul J., et al. "Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital mortality among icu patients receiving invasive mechanical ventilation: the PEPTIC randomized clinical trial." Jama 323.7 (2020): 616-626.
El-Kersh, Karim, et al. "Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study." Journal of critical care 43 (2018): 108-113.
Steinberg, Kenneth P. "Stress-related mucosal disease in the critically ill patient: risk factors and strategies to prevent stress-related bleeding in the intensive care unit." Critical care medicine 30.6 (2002): S362-S364.