The comparison between proton pump inhibitors and sucralfate in incidence of ventilator associated pneumonia in critically ill patients

Khorvash, Farzin; Abbasi, Saeed; Meidani, Mohsen; Dehdashti, Fatemeh; Ataei, Behrooz

doi:10.4103/2277-9175.125789

Cited by 24 publications

(15 citation statements)

References 6 publications

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“…Network meta-analysis estimates from 51 trials including 10 277 patients11121439404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687 demonstrated odds ratios for all comparisons close to 1.0 with moderate or very low certainty (table 1 of appendix 8). PPIs probably have no impact on mortality compared with placebo or no prophylaxis (odds ratio 1.06 (95% credible interval 0.90 to 1.28), 13 more per 1000 patients, moderate certainty, table 1 of appendix 8), and neither do H2RAs (0.96 (0.79 to 1.19), 9 fewer per 1000 patients, moderate certainty, table 1 of appendix 8).…”

Section: Resultsmentioning

confidence: 99%

“…Forty trials including 9288 patients1114394041444546474853545657596163646566676971737576798081828385909192939495979899 reported pneumonia. PPIs may increase the risk of pneumonia compared with placebo or no prophylaxis (odds ratio 1.39 (95% credible interval 0.98 to 2.10), 50 more per 1000 patients, low certainty, table 3), as may H2RAs (1.26 (0.89 to 1.85), 34 more per 1000 patients, low certainty, table 3).…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis

Wang

et al. 2020

BMJ

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ObjectiveTo determine, in critically ill patients, the relative impact of proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, or no gastrointestinal bleeding prophylaxis (or stress ulcer prophylaxis) on outcomes important to patients.DesignSystematic review and network meta-analysis.Data sourcesMedline, PubMed, Embase, Cochrane Central Register of Controlled Trials, trial registers, and grey literature up to March 2019.Eligibility criteria for selecting studies and methodsWe included randomised controlled trials that compared gastrointestinal bleeding prophylaxis with PPIs, H2RAs, or sucralfate versus one another or placebo or no prophylaxis in adult critically ill patients. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias. A parallel guideline committee (BMJ Rapid Recommendation) provided critical oversight of the systematic review, including identifying outcomes important to patients. We performed random-effects pairwise and network meta-analyses and used GRADE to assess certainty of evidence for each outcome. When results differed between low risk and high risk of bias studies, we used the former as best estimates.ResultsSeventy two trials including 12 660 patients proved eligible. For patients at highest risk (>8%) or high risk (4-8%) of bleeding, both PPIs and H2RAs probably reduce clinically important gastrointestinal bleeding compared with placebo or no prophylaxis (odds ratio for PPIs 0.61 (95% confidence interval 0.42 to 0.89), 3.3% fewer for highest risk and 2.3% fewer for high risk patients, moderate certainty; odds ratio for H2RAs 0.46 (0.27 to 0.79), 4.6% fewer for highest risk and 3.1% fewer for high risk patients, moderate certainty). Both may increase the risk of pneumonia compared with no prophylaxis (odds ratio for PPIs 1.39 (0.98 to 2.10), 5.0% more, low certainty; odds ratio for H2RAs 1.26 (0.89 to 1.85), 3.4% more, low certainty). It is likely that neither affect mortality (PPIs 1.06 (0.90 to 1.28), 1.3% more, moderate certainty; H2RAs 0.96 (0.79 to 1.19), 0.9% fewer, moderate certainty). Otherwise, results provided no support for any affect on mortality, Clostridium difficile infection, length of intensive care stay, length of hospital stay, or duration of mechanical ventilation (varying certainty of evidence).ConclusionsFor higher risk critically ill patients, PPIs and H2RAs likely result in important reductions in gastrointestinal bleeding compared with no prophylaxis; for patients at low risk, the reduction in bleeding may be unimportant. Both PPIs and H2RAs may result in important increases in pneumonia. Variable quality evidence suggested no important effects of interventions on mortality or other in-hospital morbidity outcomes.Systematic review registrationPROSPERO CRD42019126656.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis

Wang

et al. 2020

BMJ

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“…A statistically significant difference in the incidence of HAP was found in a study comparing the effects of sucralfate (14%) and a PPI (36%) (ref. 27 ). Similar findings were also reported by authors of a large retrospective study of 21.214 cardiac surgery ICU patients, with the incidence of HAP being higher in patients receiving a PPI as compared to an H2 antag 28 .…”

Section: Discussionmentioning

confidence: 99%

Possibilities for modifying risk factors for the development of hospital-acquired pneumonia in intensive care patients: results of a retrospective, observational study

Uvizl¹,

Kolář²,

Herkel³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Hospital-acquired pneumonia (HAP) development is affected by a range of risk factors. Methods. A retrospective, observational study processing data on all consecutive intensive care patients older than 18 years of age between 1 January 2011 and 31 December 2015. The aim was to determine the incidence of potential risk factors and their impact on the development of HAP. Results. A total of 2229 patients. The overall mortality was 24.0%; the mean APACHE II score 21.4. The mean length of ICU stay was 5.9 days and the mean length of hospital stay was 20.5 days. The criteria for HAP were met by 310 patients (13.9%). Early-and late-onset HAP was diagnosed in 45 (14.5%) and 265 (85.5%) patients, respectively. The mean APACHE II score was 22.1, the mean length of ICU stay was 7.6 days and the mean length of hospital stay was 23.5 days. The most important non-modifiable factors increasing the risk of HAP were multiple organ failure (OR 13.733; P<0.0001), cardiac heart disease (OR 2.255; P<0.0001) and chronic renal failure (OR 2.194; P<0.002). The most common modifiable factors were intolerance to enteral nutrition (OR 3.055; P<0.0001), urgent tracheal intubation (OR 1.511; P<0.024), reintubation (OR 1.851; P<0.001), and bronchoscopy (OR 2.558; P<0.0001). Stress ulcer prophylaxis was administered to 83% of HAP patients and 68% of patients without HAP. Prophylaxis with famotidine was associated with a lower risk of HAP in 40.0% of patients (non-HAP in 49.9%), (OR 0.669; P=0.001) than prophylaxis with pentoprazol in 42.6% and 49.5% of patients, respectively (OR 0.756; P=0.027). Conclusions. Factors associated with the highest risk of the development of HAP can be determined. Pharmacological prophylaxis of gastric and duodenal stress ulcers was identified as an independent risk factor for HAP. The study was registered in the ClinicalTrials.gov database under the number NCT02779933.

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“…[1] The prevalence of nosocomial infections in intensive care units (ICUs) is 5 to 10 times higher than that in public units. [2] The most common types of hospital infections are urinary tract infections and pneumonia. [3] Ventilator-associated pneumonia (VAP) is one of the deadliest infections, and is the cause of more than 36000 deaths each year in the United States.…”

Section: Introductionmentioning

confidence: 99%

Compliance with the standards for prevention of ventilator-associated pneumonia by nurses in the intensive care units

Tabaeian

Yazdannik

Abbasi

2017

Iranian J Nursing Midwifery Res

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Introduction:Ventilator-associated pneumonia (VAP) is the most common infection in the intensive care unit, and has many side effects such as increased mortality, increased length of hospital stay, and increased health costs. This study aimed to evaluate the compliance with the standards for prevention of VAP by nurses in the intensive care units.Materials and Methods:In this descriptive cross-sectional study, 120 nurses in 11 intensive care units of hospitals affiliated to Isfahan university of Medical Sciences, Iran, were assessed for 4 months from July to October 2014. The implementation of all measures for the prevention of VAP was investigated through observation and using a checklist.Results:The mean compliance with the standards for the prevention of VAP in the intensive care unit by the nurses was 56.32%; analysis of variance test showed significant difference between the hospitals (P < 0.001). Disposable ventilator circuit was performed for all patients; however, reviewing the patient readiness for separation from the ventilator was not conducted on a daily basis.Conclusions:Compliance with the standards for the prevention of VAP in the intensive care units was relatively acceptable; however, it still requires serious attention by the officials with training and sensitization of nurses in implementing preventive measures, especially through the provision of clinical guidelines and related protocols.

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The comparison between proton pump inhibitors and sucralfate in incidence of ventilator associated pneumonia in critically ill patients

Cited by 24 publications

References 6 publications

Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis

Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis

Possibilities for modifying risk factors for the development of hospital-acquired pneumonia in intensive care patients: results of a retrospective, observational study

Compliance with the standards for prevention of ventilator-associated pneumonia by nurses in the intensive care units

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