Effects of proton pump inhibitor versus H2-receptor antagonist stress ulcer prophylaxis on ventilator-associated pneumonia: a pilot study

Fogas, J.; Kiss, K.; Gyura, FG; Tobias, Z.; Molnár, Z.

doi:10.1186/cc12340

Cited by 9 publications

(11 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Forty three trials including 10 096 patients1112131441444546474952535455565758606163646567697374767879808182838586878990919293949596 reported clinically important gastrointestinal bleeding. Subgroup analysis based on each risk of bias criterion (concealment and blinding were highly correlated, so they were combined into one variable) showed that studies that failed to conceal or blind reported larger effect for PPIs versus H2RAs and smaller effect for H2RAs versus sucralfate (table 1 and appendix 10); for these comparisons, we focused on low risk of bias results.…”

Section: Resultsmentioning

confidence: 99%

“…Forty trials including 9288 patients1114394041444546474853545657596163646566676971737576798081828385909192939495979899 reported pneumonia. PPIs may increase the risk of pneumonia compared with placebo or no prophylaxis (odds ratio 1.39 (95% credible interval 0.98 to 2.10), 50 more per 1000 patients, low certainty, table 3), as may H2RAs (1.26 (0.89 to 1.85), 34 more per 1000 patients, low certainty, table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Overt gastrointestinal bleeding is bleeding without the consequences of clinically important gastrointestinal bleeding such as haemodynamic changes, transfusion, haemoglobin decrease, or need for surgery. Sixty five trials including 11 662 patients11121314394142434445464748495052535455565758606162636465666768697172737475767778798081828385868789909192939495969899100101102103104105106107 reported on overt bleeding. Subgroup analysis showed that concealment or blinding (the combined variable) influenced results for the comparisons of PPIs versus placebo and H2RAs versus sucralfate, and missing outcome data influenced results for PPIs versus placebo (table 4 and appendix 10).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty three trials including 3625 patients111239404143465354565961646571737879818285919596 reported duration of mechanical ventilation or duration of intubation. Results suggested no important difference between any of interventions in terms of duration of mechanical ventilation or duration of intubation (table 6 of appendix 8).…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

Wang

et al. 2020

BMJ

View full text Add to dashboard Cite

ObjectiveTo determine, in critically ill patients, the relative impact of proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, or no gastrointestinal bleeding prophylaxis (or stress ulcer prophylaxis) on outcomes important to patients.DesignSystematic review and network meta-analysis.Data sourcesMedline, PubMed, Embase, Cochrane Central Register of Controlled Trials, trial registers, and grey literature up to March 2019.Eligibility criteria for selecting studies and methodsWe included randomised controlled trials that compared gastrointestinal bleeding prophylaxis with PPIs, H2RAs, or sucralfate versus one another or placebo or no prophylaxis in adult critically ill patients. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias. A parallel guideline committee (BMJ Rapid Recommendation) provided critical oversight of the systematic review, including identifying outcomes important to patients. We performed random-effects pairwise and network meta-analyses and used GRADE to assess certainty of evidence for each outcome. When results differed between low risk and high risk of bias studies, we used the former as best estimates.ResultsSeventy two trials including 12 660 patients proved eligible. For patients at highest risk (>8%) or high risk (4-8%) of bleeding, both PPIs and H2RAs probably reduce clinically important gastrointestinal bleeding compared with placebo or no prophylaxis (odds ratio for PPIs 0.61 (95% confidence interval 0.42 to 0.89), 3.3% fewer for highest risk and 2.3% fewer for high risk patients, moderate certainty; odds ratio for H2RAs 0.46 (0.27 to 0.79), 4.6% fewer for highest risk and 3.1% fewer for high risk patients, moderate certainty). Both may increase the risk of pneumonia compared with no prophylaxis (odds ratio for PPIs 1.39 (0.98 to 2.10), 5.0% more, low certainty; odds ratio for H2RAs 1.26 (0.89 to 1.85), 3.4% more, low certainty). It is likely that neither affect mortality (PPIs 1.06 (0.90 to 1.28), 1.3% more, moderate certainty; H2RAs 0.96 (0.79 to 1.19), 0.9% fewer, moderate certainty). Otherwise, results provided no support for any affect on mortality, Clostridium difficile infection, length of intensive care stay, length of hospital stay, or duration of mechanical ventilation (varying certainty of evidence).ConclusionsFor higher risk critically ill patients, PPIs and H2RAs likely result in important reductions in gastrointestinal bleeding compared with no prophylaxis; for patients at low risk, the reduction in bleeding may be unimportant. Both PPIs and H2RAs may result in important increases in pneumonia. Variable quality evidence suggested no important effects of interventions on mortality or other in-hospital morbidity outcomes.Systematic review registrationPROSPERO CRD42019126656.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Wang

et al. 2020

BMJ

View full text Add to dashboard Cite

show abstract

“…These subgroups included high vs. low risk of bias (hypothesizing that studies with high risk of bias would have a larger treatment effect), PPI route of administration (hypothesizing that the treatment effect would be larger with parenteral administration), PPI dose (hypothesizing that treatment effect would be larger with higher dosing). In addition, we conducted a post hoc sensitivity analysis, excluding trials published in abstract form [ 20 , 23 , 32 – 35 ].…”

Section: Methodsmentioning

confidence: 99%

Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials

et al. 2016

View full text Add to dashboard Cite

BackgroundThe relative efficacy and safety of proton pump inhibitors (PPIs) compared to histamine-2-receptor antagonists (H2RAs) should guide their use in reducing bleeding risk in the critically ill.MethodsWe searched the Cochrane library, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through November 2015 without language or publication date restrictions. Only randomized controlled trials (RCTs) of PPIs vs H2RAs for stress ulcer prophylaxis in critically ill adults for clinically important bleeding, overt gastrointestinal (GI) bleeding, nosocomial pneumonia, mortality, ICU length of stay and Clostridium difficile infection were included. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess our confidence in the evidence for each outcome.ResultsIn 19 trials enrolling 2117 patients, PPIs were more effective than H2RAs in reducing the risk of clinically important GI bleeding (RR 0.39; 95 % CI 0.21, 0.71; P = 0.002; I2 = 0 %, moderate confidence) and overt GI bleeding (RR 0.48; 95 % CI 0.34, 0.66; P < 0.0001; I2 = 3 %, moderate confidence). PPI use did not significantly affect risk of pneumonia (RR 1.12; 95 % CI 0.86, 1.46; P = 0.39; I2 = 2 %, low confidence), mortality (RR 1.05; 95 % CI 0.87, 1.27; P = 0.61; I2 = 0 %, moderate confidence), or ICU length of stay (mean difference (MD), –0.38 days; 95 % CI –1.49, 0.74; P = 0.51; I2 = 30 %, low confidence). No RCT reported Clostridium difficile infection.ConclusionsPPIs were superior to H2RAs in preventing clinically important and overt GI bleeding, without significantly increasing the risk of pneumonia or mortality. Their impact on Clostridium difficile infection is yet to be determined.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1305-6) contains supplementary material, which is available to authorized users.

show abstract

Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Toews

George

Peter

et al. 2018

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Effects of proton pump inhibitor versus H2-receptor antagonist stress ulcer prophylaxis on ventilator-associated pneumonia: a pilot study

Cited by 9 publications

References 2 publications

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

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

Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials

Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Contact Info

Product

Resources

About