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, Xiaoyang; Fang, Hanyuan; Xu, Jianhua; Chen, Pei-Fu; Hu, Xujun; Chen, Bixin; Wang, Hua; Hu, Caibao; Xu, Zhaojun

doi:10.1186/s12876-019-1105-y

Cited by 18 publications

(13 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A meta-analysis also found that PPIs are more effective than H2RAs, but may also increase the risk of VAP ( Alquraini et al, 2017 ). Zhou et al believed that for high-risk critically ill patients, PPIs and H2RAs can significantly reduce gastrointestinal bleeding, with both potentially increasing the pneumonia incidence ( Zhou et al, 2019 ). Other studies had shown that there was no difference in the effect of PPI on VAP compared with H2RAs, but PPI had a better anti-gastrointestinal bleeding effect ( Arriola et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Gastric Acid Secretion Inhibitors for Ventilator-Associated Pneumonia

Liu

Zhang

et al. 2022

Front. Pharmacol.

View full text Add to dashboard Cite

Objective: This study analyzed the association of gastric acid secretion inhibitors (GASIs) [including proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs)] with the occurrence of ventilator-associated pneumonia (VAP) and in-hospital mortality in patients who received invasive mechanical ventilation (IMV).Method: Patients who received IMV and used GASI were included based on records in the MIMIC-IV database. The relationships of GASIs with VAP and the in-hospital mortality were determined using univariate and multivariate logistic regression analyses. Also, the effects of GASIs in some subgroups of the population were further analyzed.Results: A total of 18,669 patients were enrolled, including 9191 patients on H2RAs only, 6921 patients on PPIs only, and 2557 were on a combination of the two drugs. Applying logistic regression to the univariate and multivariate models revealed that compared with H2RAs, PPIs had no significant effect on the incidence of VAP, and the combination of H2RAs and PPIs was a risk factor for VAP. Compared with H2RAs, univariate logistic regression revealed that, PPIs and combine the two drugs were both risk factors for in-hospital mortality, but multivariate logistic regression showed that they were not significantly associated with in-hospital mortality. In subgroup analysis, there were interaction in different subgroups of age, PCO2, myocardial infarct, congestive heart failure (P for interaction<0.05).Conclusion: Compared with H2RAs, PPIs did not have a significant association with either VAP or in-hospital mortality; the combination of H2RAs and PPIs was risk factor for VAP, but did not have a significantly associated with in-hospital mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Patients with IMV are often associated with stress ulcer risk, and preventive application of gastric acid secretion inhibitors (GASIs) can significantly reduce gastrointestinal bleeding ( Zhou et al, 2019 ). The most commonly used drugs are proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs).…”

Section: Introductionmentioning

confidence: 99%

Effects of Gastric Acid Secretion Inhibitors for Ventilator-Associated Pneumonia

Liu

Zhang

et al. 2022

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…Recent improvements in the quality of management for these patients have decreased the incidence of upper gastrointestinal bleeding to 2‐5%. 980 However, preventing stress ulcers is important because the onset of upper gastrointestinal bleeding was correlated with an increased mortality rate. 981 Preventative methods include the administration of anti‐ulcer drugs such as acid‐suppressive medications, antacids, and mucosa protective anti‐gastric ulcer drugs.…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

“…Upper gastrointestinal bleeding associated with stress ulcers is a problem among critically ill patients such as those with sepsis. Recent improvements in the quality of management for these patients have decreased the incidence of upper gastrointestinal bleeding to 2–5% [ 1018 ]. However, preventing stress ulcers is important because the onset of upper gastrointestinal bleeding was correlated with an increased mortality rate [ 1019 ].…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

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

Cited by 18 publications

References 54 publications

Effects of Gastric Acid Secretion Inhibitors for Ventilator-Associated Pneumonia

Effects of Gastric Acid Secretion Inhibitors for Ventilator-Associated Pneumonia

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

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

Contact Info

Product

Resources

About