The online version of this article (doi:10.1186/cc9312) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
FG and YC conceived the study and helped with manuscript revisions. CL designed and performed searches. LW participated in the extraction and analysis of the data. JH was involved in drafting the manuscript and worked on manuscript revisions. All authors read and approved the final manuscript.
We conducted a meta-analysis in order to investigate the effect of histamine-2-receptor antagonists (H2RA) versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients in the intensive care unit (ICU).
A systematic literature search of Medline, EMBASE, Cochrane Central Register of Controlled Trials (1966 to January 2010) was conducted using specific search terms. A review of Web of Science and a manual review of references were also performed. Eligible studies were randomized control trials (RCTs) that compared H2RA and sucralfate for the prevention of stress ulcer in mechanically ventilated patients. Main outcome measures were rates of overt bleeding, clinically important gastrointestinal (GI) bleeding, ventilator-associated pneumonia, gastric colonization and ICU mortality.
Ten RCTs with 2,092 participants on mechanical ventilation were identified. Meta-analysis showed there was a trend toward decreased overt bleeding when H2RA was compared with sucralfate (OR = 0.87, 95% CI: 0.49 to 1.53). A total of 12 clinically important GI bleeding events occurred among 667 patients (1.8%) in the H2RA group compared with 26 events among 673 patients (3.9%) in the sucralfate groups. Prophylaxis with sucralfate decreased the incidence of gastric colonization (OR = 2.03, 95% CI: 1.29 to 3.19) and ventilator-associated pneumonia (OR = 1.32, 95% CI: 1.07 to 1.64). Subgroup analysis showed H2RA was not superior to sucralfate in reducing early-onset pneumonia (OR = 0.62, 95%CI: 0.36 to 1.07) but had a higher late-onset pneumonia rate (OR = 4.36, 95%CI: 2.09 to 9.09) relative to sucralfate. No statistically significant reduction was observed in mortality of ICU between groups (OR = 1.08, 95% CI: 0.86 to 1.34).
In patients with mechanical ventilation, H2RA resulted in no differential effectiveness in treating overt bleeding, but had higher rates of gastric colonization and ventilator-associated pneumonia. Additional RCTs of stress ulcer prophylaxis with H2RA and sucralfate are needed to establish the net benefit and risks of adverse effect in mechanically ventilated patients.
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Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR: Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986, 133: 792-796. PubMed
Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, Winton TL, Rutledge F, Todd T, Roy P, Lacroix J, Griffith L, Willan A: Risk factors for gastrointestinal bleeding in critically ill patients Canadian Critical Care Trials Group. N Engl J Med 1994, 330: 377-l381. 10.1056/NEJM199402103300601 CrossRefPubMed
Higgins JPT, Green S, (Eds): Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008]. Oxford, UK: The Cochrane Collaboration; 2008.
Cook D, Guyatt G, Marshall J, Leasa D, Fuller H, Hall R, Peters S, Rutledge F, Griffith L, McLellan A, Wood G, Kirby A: A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med 1998, 338: 791-797. 10.1056/NEJM199803193381203 CrossRefPubMed
Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F: Methods for Meta-Analysis in Medical Research. Chichester, UK: John Wiley & Sons Ltd.; 2000.
Prakash S, Rai A, Gogia AR, Prakash S: Nosocomial pneumonia in mechanically ventilated patients receiving ranitidine or sucralfate as stress ulcer prophylaxis. Indian Journal of Anaesthesia 2008, 52: 179-184.
Kantorova I, Svoboda P, Scheer P, Doubek J, Rehorkova D, Bosakova H, Ochmann J: Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology 2004, 51: 757-761. PubMed
Darlong V, Jayalakhsmi TS, Kaul HL, Tandon R: Stress ulcer prophylaxis in patients on ventilator. Trop Gastroenterol 2003, 24: 124-128. PubMed
Thomason MH, Payseur ES, Hakenewerth AM, Norton HJ, Mehta B, Reeves TR, Moore-Swartz MW, Robbins PI: Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophylaxis with sucralfate, antacid, and ranitidine. J Trauma 1996, 41: 503-508. 10.1097/00005373-199609000-00020 CrossRefPubMed
Prod'hom G, Leuenberger P, Koerfer J, Blum A, Chiolero R, Schaller MD, Perret C, Spinnler O, Blondel J, Siegrist H, Saghafi L, Blanc D, Francioli P: Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial. Ann Intern Med 1994, 120: 653-662. CrossRefPubMed
Ruiz-Santana S, Ortiz E, Gonzalez B, Bolaños J, Ruiz-Santana AJ, Manzano JL: Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment. A prospective, randomized study. Crit Care Med 1991, 19: 887-891. 10.1097/00003246-199107000-00011 CrossRefPubMed
Eddleston JM, Vohra A, Scott P, Tooth JA, Pearson RC, McCloy RF, Morton AK, Doran BH: A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate- or ranitidine-treated intensive care unit patients. Crit Care Med 1991, 19: 1491-1496. 10.1097/00003246-199112000-00009 CrossRefPubMed
Lowy FD, Carlisle PS, Adams A, Feiner C: The incidence of nosocomial pneumonia following urgent endotracheal intubation. Infect Control 1987, 8: 245-248. PubMed
Driks MR, Craven DE, Celli BR, Manning M, Burke RA, Garvin GM, Kunches LM, Farber HW, Wedel SA, McCabe WR: Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med 1987, 317: 1376-1382. 10.1056/NEJM198711263172204 CrossRefPubMed
Donowitz LG, Page MC, Mileur BL, Guenthner SH: Alteration of normal gastric flora in critical care patients receiving antacid and cimetidine therapy. Infect Control 1986, 7: 23-26. PubMed
Forster A, Niethamer T, Suter P, Pitteloud JJ, Intante F, Ducel G, Morel D: [Influence of cimetidine on bacterial growth in gastric fluid]. Nouv Presse Med 1982, 11: 2281-2283. PubMed
Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, Gibert C: Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989, 139: 877-884. CrossRefPubMed
- Effect of histamine-2-receptor antagonists versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients: a meta-analysis of 10 randomized controlled trials
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