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Clinical implications of acid-suppressive therapy in intensive care

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Created On: 01/07/2026

A medication prescribed to protect the stomach may also influence the brain and bedside management in the ICU.

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Key take away

Acid-suppressive therapy for stress ulcer prophylaxis is associated with greater sedative and analgesic requirements, increased delirium burden, and longer ICU stays in critically ill patients.

Background

A medication prescribed to protect the stomach may also influence the brain and bedside management in the ICU. As concerns grow over a possible association between acid-suppressive therapy and delirium, researchers examined whether these commonly used agents affect sedation needs, analgesic consumption, and recovery outcomes among critically ill patients.

Method

To address this question, the authors examined data from two independent critical care populations (29,112 patients from the Medical Information Mart for Intensive Care (MIMIC)-III database and 197 patients admitted to the neurointensive care unit, NICU). Advanced statistical approaches were implemented to mitigate confounding and support causal inference. The analysis focused on the relationship between acid-suppressant exposure, sedative and analgesic requirements, delirium burden, and hospitalization outcomes, while also exploring potential pathways linking these clinical events.

Result

In this retrospective cohort study, exposure to gastric acid suppressants was linked to increased treatment intensity and poorer short-term intensive care unit (ICU) outcomes. Patients receiving acid-suppressive therapy required more sedative and analgesic support, were more likely to experience delirium, and remained in intensive care for longer durations. Key observations included:

More than fivefold higher odds of increased sedation and analgesia requirements (Odds ratio 5.232; P < 0.001).
Significantly greater delirium burden (P = 0.005).
Longer ICU hospitalization (P < 0.001).
Delirium emerged as a significant mediator, accounting for 27.7% of the link between acid-suppressant exposure and increased sedative-analgesic demand.

Conclusion

The results underscored a potential trade-off associated with routine acid-suppressive therapy in critically ill patients. While commonly used for stress-ulcer prophylaxis, these agents were associated with increased sedative-analgesic requirements and a higher burden of delirium. The findings supported a more personalized approach to preventive pharmacotherapy, balancing gastrointestinal protection against potential neurocognitive consequences.