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Sucralfate versus histamine 2 receptor antagonists for stress ulcer prophylaxis in adult critically ill patients: A meta-analysis and trial sequential analysis of randomized trials

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  • Mustafa Alquraini
  • Fayez Alshamsi
  • Morten Hylander Møller
  • Emilie Belley-Cote
  • Saleh Almenawer
  • Roman Jaeschke
  • Robert MacLaren
  • Waleed Alhazzani
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PURPOSE: To determine the impact of using sucralfate versus H2RAs for SUP on patient important outcomes.

MATERIALS AND METHODS: We searched CENTRAL, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through June 2016 for randomized controlled trials (RCTs) comparing sucralfate to H2RAs for SUP in adult critically ill patients.

RESULTS: 21 RCTs enrolling 3121 patients met inclusion criteria. There was no significant difference between sucralfate compared to H2RAs in the risk of clinically important GI bleeding (risk ratio [RR] 1.19; 95% CI [confidence interval] 0.79, 1.80; P=0.42; I2=0%; low quality evidence). However, there was a statistically significant lower risk of ICU acquired pneumonia with sucralfate compared to H2RAs (RR 0.84; 95% CI 0.72, 0.98; P=0.03; I2=0%; moderate quality evidence). Sucralfate did not significantly affect the risk of death (RR 0.95; 95% CI 0.82, 1.10; P=0.51; I2=0%; high quality evidence), or duration of ICU stay in days (mean difference-0.39; 95% CI [-1.12, 0.34]; P=0.29; I2=0%; moderate quality evidence). Trial sequential analysis adjusted estimates were consistent with conventional estimates.

CONCLUSION: Moderate quality evidence suggests that sucralfate reduced ICU acquired pneumonia compared to H2RAs in adult critically ill patients, with no significant impact on GI bleeding or death.

Original languageEnglish
JournalJournal of Critical Care
Volume40
Pages (from-to)21-30
Number of pages10
ISSN0883-9441
DOIs
Publication statusPublished - Aug 2017

    Research areas

  • Journal Article

ID: 52783739