Comparing efficacy of enteral nutrition plus ranitidine and enteral nutrition alone as stress ulcer prophylaxis

Nourian, Anahid; Mohammadi, Mostafa; Beigmohammadi, Mohammad‐Taghi; Taher, Mohammad; Dadvar, Zohreh; Malekolkottab, Masoume; Ramezani, Masoud; Khalili, Hossein

doi:10.2217/cer-2017-0098

Cited by 13 publications

(27 citation statements)

References 50 publications

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“…In the meta-analysis of 12 trials [11,12,18,[24][25][26][34][35][36][37][38]43] refered to data on pneumonia, we found that administraion of SUP was not accompanied by increased risk of pneumonia, TSA further confirmed this result with the Z-curve crossing the boundary for futility ( Figure S5.A in Additional file 1). Also, negtive results were observed in sub-analysis of trials with low risk of bias ( Figure S6.A in Additional file 1), in trials used PPI as SUP( Figure S6.B in Additional file 1), in trials used H2RA as SUP ( Figure S6.B in Additional file 1), in trials with use of EN ( Figure S6.C in Additional file 1), or in trials without use of EN ( Figure S6.C in Additional file 1), TSA suggested that the pooled results were robust in subgroup of trials with low risk of bias ( Figure S5.B in Additional file 1), trials received PPI ( Figure S5.C in Additional file 1), and trials with use of EN( Figure S5.E in Additional file 1).…”

Section: Analysis Of the Secondary Outcomesmentioning

confidence: 55%

“…The detailed characteristics and clinical outcomes of the individual studies are described in Table S2 and Table S3 (see Additional file 1). Among these included RCTs [7][8][9][10][11][12][13]18,, six trials [18,24,30,36,38,43] were published in recent 3 years, seven trials [11][12][13]18,24,30,44] were multicenter, and twenty-two trials [7][8][9][10][25][26][27][28][29][31][32][33][34][35][36][37][38][39][40][41][42][43] were single-center. The discrepancy in the number of subjects between trials were large and it varied from 25 to 3298.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The discrepancy in the number of subjects between trials were large and it varied from 25 to 3298. The subjects were from medical ICU [7,25,26,30,31,38,40], surgical ICU [8,10,13,28,34,35,37,39,41,44], or both [9,11,12,18,24,27,29,32,33,36,42,43] [8,24,30,33,36,43], and it is worth mentioning that the trial by Gursoy et al [33] set 5 intervention groups and one control group, all intervention groups received PPI, hence we combined the intervention groups into a single group to compare with the control group. Notably, the trials by Kantorova et al [35] and Liu et al [37] set 2 intervention groups in which one group used PPI and another group used H2RA, therefore the control group was divided evenly into two groups to make two comparisons.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…There are 24 RCTs [7,[10][11][12]18,[24][25][26][28][29][30][32][33][34][35][36][37][38][39][40][41][42][43][44] included in analysis for all-cause mortality, the conventional meta-analysis indicated that SUP was not associated with a lower mortality compared with the control group, regardless of the trials quality ( Figure S3.A in Additional file 1), the type of SUP used ( Figure S3.B in Additional file 1), and whether EN was used ( Figure S3.C in Additional file 1).…”

Section: Analysis Of the Secondary Outcomesmentioning

confidence: 99%

“…There are 11 studies reported data on the duration of ICU stay [12,24,26,30,[33][34][35]38,[41][42][43] and 7 studies [24,26,30,34,35,38,43] reported data on the duration of MV, the pooled results suggested that use of SUP could not result in a significant reduction in the duration of ICU stay ( Figure S9 in Additional file 1) and duration of MV ( Figure S10 in Additional file 1) when compared with placebo or no prophylaxis, regardless of the trials quality, the type of SUP used, and whether EN was used.…”

Section: Analysis Of the Tertiary Outcomesmentioning

confidence: 99%

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Stress ulcer prophylaxis with proton pump inhibitors or histamine 2 receptor antagonists in critically ill adults - A meta-analysis of randomized controlled trials with trial sequential analysis.

Zhou

Fang

et al. 2019

Preprint

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Background Proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) have been widely used as stress ulcer prophylaxis (SUP) in critically ill patients, however, its efficacy and safety remain unclear. This study aimed to assess the effect of SUP on clinical outcomes in critically ill adults.Methods Literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane database of clinical trials for randomized controlled trials (RCTs) that investigated SUP, with PPI or H2RA, versus placebo or no prophylaxis in critically ill patients from database inception through 1 June 2019. Study selection, data extraction and quality assessment were performed in duplicate. The primary outcomes were clinically important gastrointestinal (GI) bleeding and overt GI bleeding. Conventional meta-analysis with random-effects model and trial sequential analysis (TSA) were performed.Results Twenty-nine RCTs were identified, of which four RCTs were judged as low risk of bias. Overall, SUP could reduce the incident of clinically important GI bleeding [relative risk(RR)= 0.58; 95% confidence intervals (CI): 0.42–0.81] and overt GI bleeding (RR= 0.48; 95% CI: 0.36–0.63), these results were confirmed by the sub-analysis of trials with low risk of bias, TSA indicated a firm evidence on its beneficial effects on the overt GI bleeding (TSA-adjusted CI: 0.31–0.75), but lack of sufficient evidence on the clinically important GI bleeding (TSA-adjusted CI: 0.23–1.51). Among patients who received enteral nutrition (EN), SUP was associated with a decreased risk of clinically important GI bleeding (RR=0.61; 95% CI: 0.44–0.85; TSA-adjusted CI: 0.16–2.38) and overt GI bleeding (RR=0.64; 95% CI: 0.42–0.96; TSA-adjusted CI: 0.12–3.35), but these benefits disappeared after adjustment with TSA. Among patients who did not receive EN, SUP had only benefits in reducing the risk of overt GI bleeding (RR=0.37; 95% CI: 0.25–0.55; TSA-adjusted CI: 0.22–0.63), but not the clinically important GI bleeding (RR=0.27; 95% CI: 0.04–2.09).Conclusions SUP has benefits on the overt GI bleeding in critically ill patients who did not receive EN, however, its benefits on clinically important GI bleeding still needs more evidence to confirm.

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Section: Analysis Of the Secondary Outcomesmentioning

confidence: 55%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Analysis Of the Secondary Outcomesmentioning

confidence: 99%

Section: Analysis Of the Tertiary Outcomesmentioning

confidence: 99%

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Stress ulcer prophylaxis with proton pump inhibitors or histamine 2 receptor antagonists in critically ill adults - A meta-analysis of randomized controlled trials with trial sequential analysis.

Zhou

Fang

et al. 2019

Preprint

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Egi

Ogura

Yatabe

et al. 2021

Acute Medicine & Surgery

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created as revised from J‐SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high‐quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J‐SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU‐acquired weakness [ICU‐AW], post‐intensive care syndrome [PICS], and body temperature management). The J‐SSCG 2020 covered a total of 22 areas with four additional new areas (patient‐ and family‐centered care, sepsis treatment system, neuro‐intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large‐scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE‐based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J‐SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: an updated systematic review and network meta-analysis of randomized trials

Wang

et al. 2020

Intensive Care Med

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Comparing efficacy of enteral nutrition plus ranitidine and enteral nutrition alone as stress ulcer prophylaxis

Abstract: EN was at least effective as ranitidine plus EN as SUP.

Cited by 13 publications

References 50 publications

Stress ulcer prophylaxis with proton pump inhibitors or histamine 2 receptor antagonists in critically ill adults - A meta-analysis of randomized controlled trials with trial sequential analysis.

Stress ulcer prophylaxis with proton pump inhibitors or histamine 2 receptor antagonists in critically ill adults - A meta-analysis of randomized controlled trials with trial sequential analysis.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: an updated systematic review and network meta-analysis of randomized trials

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