The effect of routine pantoprazole administration when compared to placebo on gastrointestinal bleeding, ventilator-associated pneumonia and Clostridium difficile infection in enterally-fed mechanically ventilated critically ill patients: A prospective randomised study

Exclusion Criteria11

• Current (prior to hospital admission) use of proton pump inhibitor or histamine-2 receptor blocker drugs
• Pregnancy
• Patients admitted with suspected or proven gastrointestinal bleeding
• Patients with a history of proven peptic ulcer disease
• Patients receiving > 400 mg/day of hydrocortisone (or equivalent of prednisolone (100mg) or dexamethasone (15mg))
• History of surgery on the oesophagus, stomach or duodenum during the current hospital admission
• Patients where the treating consultant intensive care physician believes that stress ulcer prophylaxis is either clearly indicated or contraindicated
• Patients who are Jehovah’s Witnesses
• Patients who do not receive their first dose of study medication within 36 hours of initiation of mechanical ventilation (this criterion is required to avoid contamination of cohorts as if stress ulcer prophylaxis is beneficial it is likely to be of benefit when commenced as early as possible and patients who have been ventilated at another hospital for > 24 hours may have received stress ulcer prophylaxis).
• Patients admitted for palliative care.
• Patients readmitted to the Intensive Care Unit