Bleeding and pneumonia in intensive care unit patients given PPIs and H2RAs for prevention of stress ulcer: a meta analysis

Introduction

To assess the efficacy and safety of proton pump inhibitor and histamine-2 receptor antagonist in ICU patients for stress ulcer prophylaxis.

Methods

Trials were identified by performing a systematic search of MEDLINE, Ebsco and CNKI. Two reviewers assessed the quality of studies and extracted data independently. Disagreement was resolved by discussion. Revman 4.2.2 software developed by the Cochrane collaboration was used for meta-analysis.

Results

Four trials involving 771 patients were included. Meta-analyses showed that the incidence of clinically important bleeding was significantly lower in the PPI group as compared with H2RA (OR 0.45, 95% CI (0.21, 0.9), P = 0.04). The incidence of nosocomial pneumonia (OR 1.03, 95% CI (0.63, 1.70), P = 0.89) and mortality (OR 1.17, 95% CI (0.76, 1.80), P = 0.47) had no significant difference.

Conclusions

In comparison with H2RA, PPI is more effective in the prevention of stress ulcer bleeding (SUB) in patients in intensive care. There is no significant difference in the incidence of nosocomial pneumonia and mortality between the two groups. Because the randomized controlled trials are few and these findings are based on a small number of patients, firm conclusions cannot presently be proposed. More randomized, multicenter studies with sufficient sample size should be performed.

Figure 1

PPIs vs H2RAs: bleeding rate.

Figure 2

PPIs vs H2RAs: rate of nosocomial pneumonia.