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Stress ulcer prophylaxis in intensive care unit patients receiving enteral nutrition: a systematic review and meta-analysis
- Source :
- Critical Care, Vol 22, Iss 1, Pp 1-9 (2018), Critical Care
- Publication Year :
- 2018
- Publisher :
- BMC, 2018.
-
Abstract
- Background Pharmacologic stress ulcer prophylaxis (SUP) is recommended in critically ill patients with high risk of stress-related gastrointestinal (GI) bleeding. However, as to patients receiving enteral feeding, the preventive effect of SUP is not well-known. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of pharmacologic SUP in enterally fed patients on stress-related GI bleeding and other clinical outcomes. Methods We searched PubMed, Embase, and the Cochrane database from inception through 30 Sep 2017. Eligible trials were RCTs comparing pharmacologic SUP to either placebo or no prophylaxis in enterally fed patients in the ICU. Results were expressed as risk ratio (RR) and mean difference (MD) with accompanying 95% confidence interval (CI). Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored. Results Seven studies (n = 889 patients) were included. There was no statistically significant difference in GI bleeding (RR 0.80; 95% CI, 0.49 to 1.31, p = 0.37) between groups. This finding was confirmed by further subgroup analyses and sensitivity analysis. In addition, SUP had no effect on overall mortality (RR 1.21; 95% CI, 0.94 to 1.56, p = 0.14), Clostridium difficile infection (RR 0.89; 95% CI, 0.25 to 3.19, p = 0.86), length of stay in the ICU (MD 0.04 days; 95% CI, −0.79 to 0.87, p = 0.92), duration of mechanical ventilation (MD −0.38 days; 95% CI, −1.48 to 0.72, p = 0.50), but was associated with an increased risk of hospital-acquired pneumonia (RR 1.53; 95% CI, 1.04 to 2.27; p = 0.03). Conclusions Our results suggested that in patients receiving enteral feeding, pharmacologic SUP is not beneficial and combined interventions may even increase the risk of nosocomial pneumonia. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1937-1) contains supplementary material, which is available to authorized users.
- Subjects :
- medicine.medical_specialty
Peptic Ulcer
Time Factors
Critical Care
Stress ulcer prophylaxis
Subgroup analysis
Critical Care and Intensive Care Medicine
Placebo
Enteral administration
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
medicine
Humans
030212 general & internal medicine
Hospital Mortality
Critically ill
Risk Management
business.industry
Stress ulcer
Research
lcsh:Medical emergencies. Critical care. Intensive care. First aid
030208 emergency & critical care medicine
lcsh:RC86-88.9
Length of Stay
medicine.disease
Intensive care unit
Respiration, Artificial
Intensive Care Units
Meta-analysis
Parenteral nutrition
Histamine H2 Antagonists
Relative risk
Duodenal Ulcer
Clostridium Infections
business
Gastrointestinal Hemorrhage
Enteral nutrition
Subjects
Details
- Language :
- English
- ISSN :
- 13648535
- Volume :
- 22
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Critical Care
- Accession number :
- edsair.doi.dedup.....52b41e2f6f5ba3e37d35252ed7a459d0