Proton pump inhibitors for gastrointestinal bleeding prophylaxis in critically ill patients: A systematic review protocol
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Proton pump inhibitors for gastrointestinal bleeding prophylaxis in critically ill patients : A systematic review protocol. / Wang, Ying; Heels-Ansdell, Diane; Ge, Long; Parpia, Sameer; Ibrahim, Quazi; Cook, Deborah; Deane, Adam; Lauzier, Francois; Hammond, Naomi; Møller, Morten H.; Krag, Mette; Perner, Anders; Guyatt, Gordon H.
In: Acta Anaesthesiologica Scandinavica, 2024.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Proton pump inhibitors for gastrointestinal bleeding prophylaxis in critically ill patients
T2 - A systematic review protocol
AU - Wang, Ying
AU - Heels-Ansdell, Diane
AU - Ge, Long
AU - Parpia, Sameer
AU - Ibrahim, Quazi
AU - Cook, Deborah
AU - Deane, Adam
AU - Lauzier, Francois
AU - Hammond, Naomi
AU - Møller, Morten H.
AU - Krag, Mette
AU - Perner, Anders
AU - Guyatt, Gordon H.
N1 - Publisher Copyright: © 2024 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
PY - 2024
Y1 - 2024
N2 - Background: Proton pump inhibitors (PPIs) are the most commonly prescribed drugs for preventing upper gastrointestinal bleeding in critically ill patients. However, concerns have arisen about the possible harms of using PPIs, including potentially increased risk of pneumonia, Clostridioides difficile infection, and more seriously, an increased risk of death in the most severely ill patients. Triggered by the REVISE trial, which is a forthcoming large randomized trial comparing pantoprazole to placebo in invasively mechanically ventilated patients, we will conduct this systematic review to evaluate the efficacy and safety of PPIs versus no prophylaxis for critically ill patients. Methods: We will systematically search randomized trials that compared gastrointestinal bleeding prophylaxis with PPIs versus placebo or no prophylaxis in adults in the intensive care unit (ICU). Pairs of reviewers will independently screen the literature, and for those eligible trials, extract data and assess risk of bias. We will perform meta-analyses using a random-effects model, and calculate relative risks for dichotomous outcomes and mean differences for continuous outcomes, and the associated 95% confidence intervals. We will conduct subgroup analysis to explore whether the impact of PPIs on mortality differs in more and less severely ill patients. We will assess certainty of evidence using the GRADE approach. Discussion: This systematic review will provide the most up-to-date evidence regarding the merits and limitations of stress ulcer prophylaxis with PPIs in critically ill patients in contemporary practice.
AB - Background: Proton pump inhibitors (PPIs) are the most commonly prescribed drugs for preventing upper gastrointestinal bleeding in critically ill patients. However, concerns have arisen about the possible harms of using PPIs, including potentially increased risk of pneumonia, Clostridioides difficile infection, and more seriously, an increased risk of death in the most severely ill patients. Triggered by the REVISE trial, which is a forthcoming large randomized trial comparing pantoprazole to placebo in invasively mechanically ventilated patients, we will conduct this systematic review to evaluate the efficacy and safety of PPIs versus no prophylaxis for critically ill patients. Methods: We will systematically search randomized trials that compared gastrointestinal bleeding prophylaxis with PPIs versus placebo or no prophylaxis in adults in the intensive care unit (ICU). Pairs of reviewers will independently screen the literature, and for those eligible trials, extract data and assess risk of bias. We will perform meta-analyses using a random-effects model, and calculate relative risks for dichotomous outcomes and mean differences for continuous outcomes, and the associated 95% confidence intervals. We will conduct subgroup analysis to explore whether the impact of PPIs on mortality differs in more and less severely ill patients. We will assess certainty of evidence using the GRADE approach. Discussion: This systematic review will provide the most up-to-date evidence regarding the merits and limitations of stress ulcer prophylaxis with PPIs in critically ill patients in contemporary practice.
KW - gastrointestinal bleeding prophylaxis
KW - proton pump inhibitors
KW - stress ulcer prophylaxis
KW - systematic review protocol
U2 - 10.1111/aas.14426
DO - 10.1111/aas.14426
M3 - Review
C2 - 38581102
AN - SCOPUS:85189968854
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
ER -
ID: 395992200