Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials
Fayez Alshamsi,Fayez Alshamsi,Emilie P. Belley-Côté,Deborah J. Cook,Saleh A. Almenawer,Zuhoor Alqahtani,Dan Perri,Lehana Thabane,Awad Al-Omari,Kim M. Lewis,Gordon H. Guyatt,Waleed Alhazzani,Waleed Alhazzani +12 more
TLDR
PPIs were superior to H2RAs in preventing clinically important and overt GI bleeding, without significantly increasing the risk of pneumonia or mortality, and on Clostridium difficile infection.Abstract:
The relative efficacy and safety of proton pump inhibitors (PPIs) compared to histamine-2-receptor antagonists (H2RAs) should guide their use in reducing bleeding risk in the critically ill. We searched the Cochrane library, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through November 2015 without language or publication date restrictions. Only randomized controlled trials (RCTs) of PPIs vs H2RAs for stress ulcer prophylaxis in critically ill adults for clinically important bleeding, overt gastrointestinal (GI) bleeding, nosocomial pneumonia, mortality, ICU length of stay and Clostridium difficile infection were included. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess our confidence in the evidence for each outcome. In 19 trials enrolling 2117 patients, PPIs were more effective than H2RAs in reducing the risk of clinically important GI bleeding (RR 0.39; 95 % CI 0.21, 0.71; P = 0.002; I
2
= 0 %, moderate confidence) and overt GI bleeding (RR 0.48; 95 % CI 0.34, 0.66; P < 0.0001; I
2
= 3 %, moderate confidence). PPI use did not significantly affect risk of pneumonia (RR 1.12; 95 % CI 0.86, 1.46; P = 0.39; I
2
= 2 %, low confidence), mortality (RR 1.05; 95 % CI 0.87, 1.27; P = 0.61; I
2
= 0 %, moderate confidence), or ICU length of stay (mean difference (MD), –0.38 days; 95 % CI –1.49, 0.74; P = 0.51; I
2
= 30 %, low confidence). No RCT reported Clostridium difficile infection. PPIs were superior to H2RAs in preventing clinically important and overt GI bleeding, without significantly increasing the risk of pneumonia or mortality. Their impact on Clostridium difficile infection is yet to be determined.read more
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Andrew Rhodes,Laura Evans,Waleed Alhazzani,Mitchell M. Levy,Massimo Antonelli,Ricard Ferrer,Anand Kumar,Jonathan E. Sevransky,Charles L. Sprung,Mark E. Nunnally,Bram Rochwerg,Gordon D. Rubenfeld,Derek C. Angus,Djillali Annane,Richard Beale,Geoffrey J. Bellinghan,Gordon R. Bernard,Jean Daniel Chiche,Craig M. Coopersmith,Daniel De Backer,Craig French,Seitaro Fujishima,Herwig Gerlach,Jorge Hidalgo,Steven M. Hollenberg,Alan E. Jones,Dilip R. Karnad,Ruth M. Kleinpell,Younsuck Koh,Thiago Lisboa,Flávia Ribeiro Machado,John J. Marini,John C. Marshall,John E. Mazuski,Lauralyn McIntyre,Anthony S. McLean,Sangeeta Mehta,Rui Moreno,John Myburgh,Paolo Navalesi,Osamu Nishida,Tiffany M. Osborn,Anders Perner,Colleen M. Plunkett,Marco Ranieri,Christa A. Schorr,Maureen A. Seckel,Christopher W. Seymour,Lisa Shieh,Khalid A. Shukri,Steven Q. Simpson,Mervyn Singer,B. Taylor Thompson,Sean R. Townsend,Thomas Van der Poll,Jean Louis Vincent,W. Joost Wiersinga,Janice L. Zimmerman,R. Phillip Dellinger +58 more
TL;DR: Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
Andrew Rhodes,Laura Evans,Waleed Alhazzani,Mitchell M. Levy,Massimo Antonelli,Ricard Ferrer,Anand Kumar,Jonathan E. Sevransky,Charles L. Sprung,Mark E. Nunnally,Bram Rochwerg,Gordon D. Rubenfeld,Derek C. Angus,Djillali Annane,Richard Beale,Geoffrey J. Bellinghan,Gordon R. Bernard,Jean Daniel Chiche,Craig M. Coopersmith,Daniel De Backer,Craig French,Seitaro Fujishima,Herwig Gerlach,Jorge Hidalgo,Steven M. Hollenberg,Alan E. Jones,Dilip R. Karnad,Ruth M. Kleinpell,Younsuck Koh,Thiago Lisboa,Flávia Ribeiro Machado,John J. Marini,John C. Marshall,John E. Mazuski,Lauralyn McIntyre,Anthony S. McLean,Sangeeta Mehta,Rui Moreno,John Myburgh,Paolo Navalesi,Osamu Nishida,Tiffany M. Osborn,Anders Perner,Colleen M. Plunkett,Marco Ranieri,Christa A. Schorr,Maureen A. Seckel,Christopher W. Seymour,Lisa Shieh,Khalid A. Shukri,Steven Q. Simpson,Mervyn Singer,B. Taylor Thompson,Sean R. Townsend,Thomas Van der Poll,Jean Louis Vincent,W. Joost Wiersinga,Janice L. Zimmerman,R. Phillip Dellinger +58 more
TL;DR: A consensus committee of 55 international experts representing 25 international organizations was assembled at key international meetings (forSurviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012 as discussed by the authors ).
Journal ArticleDOI
Effective and safe proton pump inhibitor therapy in acid-related diseases - A position paper addressing benefits and potential harms of acid suppression
TL;DR: Overall, PPIs are irreplaceable drugs in the management of acid-related diseases, however, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects.
Journal ArticleDOI
Proton-pump inhibitors: understanding the complications and risks
TL;DR: As discussed in this Review, most associations of PPIs with severe adverse events are not based on sufficient evidence because of confounding factors and a lack of plausible mechanisms, so a causal relationship remains unproven in most associations, and further studies are needed.
Journal ArticleDOI
Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials.
Benjamin Scally,Benjamin Scally,Jonathan Emberson,Enti Spata,Christina Reith,Kelly Davies,Heather Halls,Lisa Holland,Kate Wilson,Neeraj Bhala,Christopher J. Hawkey,Marc C. Hochberg,Richard H. Hunt,Loren Laine,Angel Lanas,Carlo Patrono,Colin Baigent +16 more
TL;DR: The effects of proton-pump inhibitors, prostaglandin analogues, and histamine-2 receptor antagonists in different clinical circumstances by doing meta-analyses of tabular data from all relevant unconfounded randomised trials of gastroprotectant drugs were examined.
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