4.6 Review

Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients

期刊

INTENSIVE CARE MEDICINE
卷 40, 期 1, 页码 11-22

出版社

SPRINGER
DOI: 10.1007/s00134-013-3125-3

关键词

Stress ulceration; Gastrointestinal bleeding; All-cause mortality; Meta-analysis; Trial sequential analysis; Stress ulcer prophylaxis

向作者/读者索取更多资源

To assess the effects of stress ulcer prophylaxis (SUP) versus placebo or no prophylaxis on all-cause mortality, gastrointestinal (GI) bleeding and hospital-acquired pneumonia in adult critically ill patients in the intensive care unit (ICU). We performed a systematic review using meta-analysis and trial sequential analysis (TSA). Eligible trials were randomised clinical trials comparing proton pump inhibitors or histamine 2 receptor antagonists with either placebo or no prophylaxis. Two reviewers independently assessed studies for inclusion and extracted data. The Cochrane Collaboration methodology was used. Risk ratios/relative risks (RR) with 95 % confidence intervals (CI) were estimated. The predefined outcome measures were all-cause mortality, GI bleeding, and hospital-acquired pneumonia. Twenty trials (n = 1,971) were included; all were judged as having a high risk of bias. There was no statistically significant difference in mortality (fixed effect: RR 1.00, 95 % CI 0.84-1.20; P = 0.87; I (2) = 0 %) or hospital-acquired pneumonia (random effects: RR 1.23, 95 % CI 0.86-1.78; P = 0.28; I (2) = 19 %) between SUP patients and the no prophylaxis/placebo patients. These findings were confirmed in the TSA. With respect to GI bleeding, a statistically significant difference was found in the conventional meta-analysis (random effects: RR 0.44, 95 % CI 0.28-0.68; P = 0.01; I (2) = 48 %); however, TSA (TSA adjusted 95 % CI 0.18-1.11) and subgroup analyses could not confirm this finding. This systematic review using meta-analysis and TSA demonstrated that both the quality and the quantity of evidence supporting the use of SUP in adult ICU patients is low. Consequently, large randomised clinical trials are warranted.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.6
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据