+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Risks and benefits of stress ulcer prophylaxis in adult neurocritical care patients: a systematic review and meta-analysis of randomized controlled trials



Risks and benefits of stress ulcer prophylaxis in adult neurocritical care patients: a systematic review and meta-analysis of randomized controlled trials



Critical Care 19: 409



Neurocritical care patients are at high risk for stress-related upper gastrointestinal (UGI) bleeding. The aim of this meta-analysis was to evaluate the risks and benefits of stress ulcer prophylaxis (SUP) in this patient group. A systematic search of major electronic literature databases was conducted. Eligible studies were randomized controlled trials (RCTs) in which researchers compared the effects of SUP (with proton pump inhibitors or histamine 2 receptor antagonists) with placebo or no prophylaxis in neurocritical care patients. The primary outcome was UGI bleeding, and secondary outcomes were all-cause mortality and nosocomial pneumonia. Study heterogeneity was sought and quantified. The results were reported as risk ratios/relative risks (RRs) with 95 % confidence intervals (CIs). We included 8 RCTs comprising an aggregate of 829 neurocritical care patients. Among these trials, one study conducted in a non-intensive care unit setting that did not meet our inclusion criteria was ultimately included based on further evaluation. All studies were judged as having a high or unclear risk of bias. SUP was more effective than placebo or no prophylaxis at reducing UGI bleeding (random effects: RR 0.31; 95 % CI 0.20-0.47; P < 0.00001; I (2) = 45 %) and all-cause mortality (fixed effects: RR 0.70; 95 % CI 0.50-0.98; P = 0.04; I (2) = 0 %). There was no difference between SUP and placebo or no prophylaxis regarding nosocomial pneumonia (random effects: RR 1.14; 95 % CI 0.67-1.94; P = 0.62; I (2) = 42 %). The slight asymmetry of the funnel plots raised the concern of small trial bias, and apparent heterogeneity existed in participants, interventions, control treatments, and outcome measures. In neurocritical care patients, SUP seems to be more effective than placebo or no prophylaxis in preventing UGI bleeding and reducing all-cause mortality while not increasing the risk of nosocomial pneumonia. The robustness of this conclusion is limited by a lack of trials with a low risk of bias, sparse data, heterogeneity among trials, and a concern regarding small trial bias. International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42015015802 . Date of registration: 6 Jan 2015.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 058781697

Download citation: RISBibTeXText

PMID: 26577436

DOI: 10.1186/s13054-015-1107-2


Related references

Risks and Benefits of Exercise Training in Adults With Congenital Heart Disease. Canadian Journal of Cardiology 32(4): 459-466, 2016

Efficacy and safety of protein C concentrate to treat purpura fulminans and thromboembolic events in severe congenital protein C deficiency. Thrombosis and Haemostasis 116(1): 58-68, 2016

Clinical examination: a trigger but not a substitute for hemodynamic evaluation. Intensive Care Medicine 45(2): 269-271, 2019

Stress ulcer prophylaxis in the nonintensive care unit hospitalized patient: physician prescribing behaviors. Southern Medical Journal 103(12): 1195, 2010

Prevalence of acute kidney injury after liver transplantation in children: Comparison of the pRIFLE, AKIN, and KDIGO criteria using corrected serum creatinine. Journal of Critical Care 50: 275-279, 2019

Stress ulcer prophylaxis in the intensive care unit trial: detailed statistical analysis plan. Acta Anaesthesiologica Scandinavica 61(7): 859-868, 2017

Use of inhaled corticosteroids decreases hospital admissions for asthma in young children. World Journal of Pediatrics 5(3): 177-181, 2009

Sucralfate suspension for mouth ulcers. Drug Intelligence and Clinical Pharmacy 19(6): 480, 1985

Antibiotic prophylaxis for hernia repair. Cochrane Database of Systematic Reviews 2003(2): Cd003769, 2003

Prophylaxis of Piroplasma infections of cattle in the Chechen Ingush ASSR. Arakhnozy i protozoinye bolezni sel'skokhoziaistvennykh zhivotnykh: 13-121, 1977

Effect of histamine on the signal transduction of the AtoS-AtoC two component system and involvement in poly-(R)-3-hydroxybutyrate biosynthesis in Escherichia coli. Amino Acids 35(1): 45-52, 2008

Physical and psychosexual pubertal development: physiology and pathophysiology of puberty with lessons learned from those with disorders of sex development. Pediatric Endocrinology Reviews 6(2): 248-256, 2008

ACl/2Gpi and aPs/Pt show synergic thrombogenic effects in suppressing anticoagulant activity of Apc and stimulating tissue factor expression and Tnf- secretion by mononuclear cells. Thrombosis Research 181: 52-58, 2019

Heat and Hypoxic Acclimation Increase Monocyte Heat Shock Protein 72 but Do Not Attenuate Inflammation following Hypoxic Exercise. Frontiers in Physiology 8: 811, 2017

Stress ulcer prophylaxis in adult intensive care unit patients - a protocol for a systematic review. Acta Anaesthesiologica Scandinavica 62(6): 744-755, 2018