Pharmacological interventions for stress ulcer prophylaxis in critically ill patients: a mixed treatment comparison network meta-analysis and a recursive cumulative meta-analysis

2017 ◽  
Vol 19 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Kannan Sridharan ◽  
Gowri Sivaramakrishnan ◽  
Jerome Gnanaraj
CHEST Journal ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. A345
Author(s):  
Diwas Shahi ◽  
Ajai Rajabalan ◽  
Jonathan Barrera-Calix ◽  
Sunil Paudel ◽  
Tamer Said Ahmed ◽  
...  

2017 ◽  
Vol 44 (2) ◽  
pp. 277-278 ◽  
Author(s):  
Waleed Alhazzani ◽  
Fayez Alshamsi ◽  
Emilie Belley-Cote ◽  
Diane Heels-Ansdell ◽  
Romina Brignardello-Petersen ◽  
...  

2017 ◽  
Vol 44 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Waleed Alhazzani ◽  
Fayez Alshamsi ◽  
Emilie Belley-Cote ◽  
Diane Heels-Ansdell ◽  
Romina Brignardello-Petersen ◽  
...  

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Saeed Mohamed Ibrahim ◽  
Sameh Salem Hefni Taha ◽  
Samuel Habachi Daniel ◽  
Emil Noshy Aziz Salh

Abstract Background Sfress Ulceration was an important cause of morbidity and mortality in critically ill patients. Early active treatment reduces the risk of clinically significant bleeding, ulcer prophylaxis therefore became a standard of care in all critically ill patients. Objective The overall aims of the Stress ulcer prophylaxis in the critically ill patients is to determine the benefits and risks of stress ulcer prophylaxis stress ulcer prophylaxis (SUP) in intensive care unit Materials and Methods We performed this systematic review and meta-analysis according to the recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In the our systematic review and meta-analysis, we searched Medline via PubMed, CENTRAL, Web of Science, SCOPUS, and Google Scholar from March 1977 till August 2019. The search retrieved 2289 unique records. We then obtained 237 final results for full-text screening. At last, 28 recorded studies were involved in our in the present study. Results 23 included studies reported the rates of clinically important GI bleeding. The overall effect estimates favored SUP over control for decreasing the hazards of clinically significant GI hemorrhage (P value <0.001, OR— 0.55, CI of 95%[0.35 0.86]). The overall effect estimates did not favor SUP over control for reducing the rate of death (P value =0.24, OR 1.21, 95% CI [0.87 — 1.69]). 23 studies reported the rates of pneumonia. The overall effect estimates showed that the SUP was not related to elevated hazards of nosocomial pneumonia over control (P value —0.15, OR —1.5, CI of 95% [0.83 3.02]). The analysis showed that only Cimetidine 900 mg was effective in reducing the incidence of clinically important GI bleeding (OR 0.45 [0.24, 0.82], p *0.009). In contrary, none of the included PPIs (pantoprazole, lansoprazole, omeprazole), ranitidine, or sucralfate were effective in reducing the incidence of clinically important GI bleeding. Conclusion SUP is associated with lower risk of GI bleeding in critically ill patients; however, the current published literature shows significant inconsistency. Our analysis showed that, no significant difference between H2RA and PPI in term of incidence of clinically important GI bleeding, H2RAs (mainly cimetidine) more effective than other classes of SUP which significantly reduced the risk of overt GI hemorrhage, and none of the drug classes was effective in reducing the mortality rates.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaoyang Zhou ◽  
Hanyuan Fang ◽  
Jianfei Xu ◽  
Peifu Chen ◽  
Xujun Hu ◽  
...  

Abstract 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.


Sign in / Sign up

Export Citation Format

Share Document