Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis

Autor: Søren Marker, Anders Granholm, Janus Christian Jakobsen, Carl Thomas Anthon, Jørn Wetterslev, Mette Krag, Marija Barbateskovic, Anders Perner, Morten Hylander Møller
Rok vydání: 2019
Předmět:
Proton Pump Inhibitors/therapeutic use
medicine.medical_specialty
Proton pump inhibitors
Histamine H2 Antagonists/therapeutic use
Stress ulcer prophylaxis
Gastrointestinal haemorrhage
Critical Care and Intensive Care Medicine
Placebo
law.invention
03 medical and health sciences
0302 clinical medicine
law
Internal medicine
Intensive care
medicine
Humans
Stomach Ulcer
Adverse effect
Histamine-2 receptor antagonists
Stress
Psychological/complications
Pre-Exposure Prophylaxis/methods
Peptic ulcer
Intensive Care Units/organization & administration
business.industry
Stress ulcer
Proton Pump Inhibitors
030208 emergency & critical care medicine
medicine.disease
Intensive care unit
Clinical trial
Critical care
Meta-analysis
Intensive Care Units
Pneumonia
Histamine H2 Antagonists
030228 respiratory system
Stomach Ulcer/drug therapy
Relative risk
Pre-Exposure Prophylaxis
business
Stress
Psychological
Zdroj: Barbateskovic, M, Marker, S, Granholm, A, Anthon, C T, Krag, M, Jakobsen, J C, Perner, A, Wetterslev, J & Møller, M H 2019, ' Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients : a systematic review with meta-analysis and trial sequential analysis ', Intensive Care Medicine, vol. 45, no. 2, pp. 143-158 . https://doi.org/10.1007/s00134-019-05526-z
ISSN: 1432-1238
0342-4642
DOI: 10.1007/s00134-019-05526-z
Popis: Purpose: Most intensive care unit (ICU) patients receive stress ulcer prophylaxis. We present updated evidence on the effects of prophylactic proton pump inhibitors (PPIs) or histamine 2 receptor antagonists (H2RAs) versus placebo/no prophylaxis on patient-important outcomes in adult ICU patients. Methods: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised clinical trials assessing the effects of PPI/H2RA versus placebo/no prophylaxis on mortality, gastrointestinal (GI) bleeding, serious adverse events (SAEs), health-related quality of life (HRQoL), myocardial ischemia, pneumonia, and Clostridium (Cl.) difficile enteritis in ICU patients. Results: We identified 42 trials randomising 6899 ICU patients; 3 had overall low risk of bias. We did not find an effect of stress ulcer prophylaxis on mortality [relative risk 1.03, 95% confidence interval (CI) 0.94–1.14; TSA-adjusted CI 0.94–1.14], but the occurrence of any GI bleeding was reduced as compared with placebo/no prophylaxis (0.60, 95% CI 0.47–0.77; TSA-adjusted CI 0.36–1.00). The conventional meta-analysis indicated that clinically important GI bleeding was reduced (RR 0.63, 95% CI 0.48–0.81), but the TSA-adjusted CI 0.35–1.13 indicated lack of firm evidence. The effects of stress ulcer prophylaxis on SAEs, HRQoL, pneumonia, myocardial ischemia and Cl. difficile enteritis are uncertain. Conclusions: In this updated systematic review, we were able to refute a relative change of 20% of mortality. The occurrence of GI bleeding was reduced, but we lack firm evidence for a reduction in clinically important GI bleeding. The effects on SAEs, HRQoL, pneumonia, myocardial ischemia and Cl. difficile enteritis remain inconclusive.
Databáze: OpenAIRE
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