Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis

45 Citations (Scopus)

Abstract

PURPOSE: Most intensive care unit (ICU) patients receive stress ulcer prophylaxis. We present updated evidence on the effects of prophylactic proton pump inhibitors (PPIs) or histamine 2 receptor antagonists (H2RAs) versus placebo/no prophylaxis on patient-important outcomes in adult ICU patients.

METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised clinical trials assessing the effects of PPI/H2RA versus placebo/no prophylaxis on mortality, gastrointestinal (GI) bleeding, serious adverse events (SAEs), health-related quality of life (HRQoL), myocardial ischemia, pneumonia, and Clostridium (Cl.) difficile enteritis in ICU patients.

RESULTS: We identified 42 trials randomising 6899 ICU patients; 3 had overall low risk of bias. We did not find an effect of stress ulcer prophylaxis on mortality [relative risk 1.03, 95% confidence interval (CI) 0.94-1.14; TSA-adjusted CI 0.94-1.14], but the occurrence of any GI bleeding was reduced as compared with placebo/no prophylaxis (0.60, 95% CI 0.47-0.77; TSA-adjusted CI 0.36-1.00). The conventional meta-analysis indicated that clinically important GI bleeding was reduced (RR 0.63, 95% CI 0.48-0.81), but the TSA-adjusted CI 0.35-1.13 indicated lack of firm evidence. The effects of stress ulcer prophylaxis on SAEs, HRQoL, pneumonia, myocardial ischemia and Cl. difficile enteritis are uncertain.

CONCLUSIONS: In this updated systematic review, we were able to refute a relative change of 20% of mortality. The occurrence of GI bleeding was reduced, but we lack firm evidence for a reduction in clinically important GI bleeding. The effects on SAEs, HRQoL, pneumonia, myocardial ischemia and Cl. difficile enteritis remain inconclusive.

Original languageEnglish
JournalIntensive Care Medicine
Volume45
Issue number2
Pages (from-to)143-158
Number of pages16
ISSN0342-4642
DOIs
Publication statusPublished - 27 Feb 2019

Keywords

  • Critical care
  • Gastrointestinal haemorrhage
  • Histamine-2 receptor antagonists
  • Meta-analysis
  • Peptic ulcer
  • Proton pump inhibitors
  • Stress ulcer prophylaxis
  • Stress, Psychological/complications
  • Humans
  • Stomach Ulcer/drug therapy
  • Histamine H2 Antagonists/therapeutic use
  • Proton Pump Inhibitors/therapeutic use
  • Intensive Care Units/organization & administration
  • Pre-Exposure Prophylaxis/methods

Fingerprint

Dive into the research topics of 'Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis'. Together they form a unique fingerprint.

Cite this