Goals and Background: 

Stress ulcer prophylaxis has been shown to lower gastrointestinal bleeding (GIB) rates. Various agents have been studied, and the optimal strategy continues to be contested. This study evaluates the efficacy between proton pump inhibitors (PPIs) and histamine-2-receptor antagonists. Small sample sizes and methodology flaws limited prior studies.

Study: 

A systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science, and ClinicalTrials.gov for randomized controlled trials reporting the use of PPI and histamine-2-receptor antagonist reporting rates of GIB and standardized intensive care outcomes. Risk ratios (RR) and standardized mean difference (SMD) with 95% confidence intervals (CIs). A trial sequential analysis was performed to guard against errors.

Results: 

A total of 14 randomized controlled trials of 28,526 patients with a mean age of 57.83±17.35 years and 30.82% females. In our pooled analysis, PPI outperformed its comparator (RR: 0.68; 95% CI: 0.57-0.82) in clinically significant GIB. PPI re-demonstrated significant reduction in overt GIB (RR: 0.61; 95% CI: 0.39-0.97). No differences between groups was noted toward all-cause mortality (RR: 1.05; 95% CI: 1.00-1.10) or incidence of pneumonia (RR: 1.11; 95% CI: 0.82-1.51). Duration of stay (SMD: 0.07; 95% CI: −0.04-0.17) and ventilator days (SMD: 0.01; 95% CI: −0.01-0.04) were indifferent between the groups.

Conclusions: 

Among critically ill patients, PPI was associated with reduced clinically significant or overt GIB. No differences in pneumonia were seen with the use of either agent. Trial sequential analysis for clinically significant GIB ruled out the risk for false-positive results, and thereby it is unlikely that future trials will affect our conclusions.

中文翻译：

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质子泵抑制剂与组胺 2 受体拮抗剂用于危重患者应激性溃疡预防：荟萃分析和试验序贯分析

目标和背景： 

应激性溃疡预防已被证明可以降低胃肠道出血 (GIB) 率。人们已经对各种代理进行了研究，并且最佳策略仍在继续争论。本研究评估了质子泵抑制剂 (PPI) 和组胺 2 受体拮抗剂之间的疗效。小样本量和方法缺陷限制了先前的研究。

学习： 

对 MEDLINE、EMBASE、CENTRAL、Web of Science 和 ClinicalTrials.gov 进行系统检索，查找报告使用 PPI 和组胺 2 受体拮抗剂的随机对照试验，报告 GIB 发生率和标准化重症监护结果。风险比 (RR) 和标准化均差 (SMD)，置信区间 (CI) 为 95%。进行了试验序贯分析以防止错误。

结果： 

共有 14 项随机对照试验，纳入 28,526 名患者，平均年龄为 57.83±17.35 岁，其中 30.82% 为女性。在我们的汇总分析中，PPI 在临床显着的 GIB 方面优于其比较药物（RR：0.68；95% CI：0.57-0.82）。PPI 再次显示显性 GIB 显着降低（RR：0.61；95% CI：0.39-0.97）。各组之间的全因死亡率（RR：1.05；95% CI：1.00-1.10）或肺炎发生率（RR：1.11；95% CI：0.82-1.51）没有差异。各组之间的住院时间（SMD：0.07；95% CI：-0.04-0.17）和呼吸机天数（SMD：0.01；95% CI：-0.01-0.04）无差异。

结论： 

在危重患者中，PPI 与临床显着或明显的 GIB 减少相关。使用这两种药物在肺炎方面没有发现差异。对具有临床意义的 GIB 的试验序贯分析排除了假阳性结果的风险，因此未来的试验不太可能影响我们的结论。