Stress ulcer prophylaxis in intensive care unit patients receiving enteral nutrition: a systematic review and meta-analysis

• Published in: Critical care (London, England) Vol. 22; no. 1; pp. 20 - 9
• Main Authors: Huang, Hui-Bin, Jiang, Wei, Wang, Chun-Yao, Qin, Han-Yu, Du, Bin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28.01.2018; BioMed Central; BMC
• Subjects: Analysis; Care and treatment; Clostridium Infections - epidemiology; Clostridium Infections - prevention & control; Critical Care - methods; Critically ill; Critically ill persons; Duodenal Ulcer - drug therapy; Duodenal Ulcer - mortality; Duodenal Ulcer - prevention & control; Enteral nutrition; Enteral Nutrition - methods; Gastrointestinal hemorrhage; Gastrointestinal Hemorrhage - prevention & control; Health aspects; Histamine H2 Antagonists - pharmacology; Histamine H2 Antagonists - therapeutic use; Hospital Mortality; Humans; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Length of Stay - trends; Meta-analysis; Peptic Ulcer - drug therapy; Peptic Ulcer - mortality; Peptic Ulcer - prevention & control; Pneumonia; Prophylaxis; Respiration, Artificial - methods; Respiration, Artificial - trends; Risk factors; Risk Management - methods; Stress ulcer prophylaxis; Time Factors; Enteral nutrition; Critically ill; Stress ulcer prophylaxis; Meta-analysis
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1466-609X
• DOI: 10.1186/s13054-017-1937-1

Pharmacologic stress ulcer prophylaxis (SUP) is recommended in critically ill patients with high risk of stress-related gastrointestinal (GI) bleeding. However, as to patients receiving enteral feeding, the preventive effect of SUP is not well-known. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of pharmacologic SUP in enterally fed patients on stress-related GI bleeding and other clinical outcomes. We searched PubMed, Embase, and the Cochrane database from inception through 30 Sep 2017. Eligible trials were RCTs comparing pharmacologic SUP to either placebo or no prophylaxis in enterally fed patients in the ICU. Results were expressed as risk ratio (RR) and mean difference (MD) with accompanying 95% confidence interval (CI). Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored. Seven studies (n = 889 patients) were included. There was no statistically significant difference in GI bleeding (RR 0.80; 95% CI, 0.49 to 1.31, p = 0.37) between groups. This finding was confirmed by further subgroup analyses and sensitivity analysis. In addition, SUP had no effect on overall mortality (RR 1.21; 95% CI, 0.94 to 1.56, p = 0.14), Clostridium difficile infection (RR 0.89; 95% CI, 0.25 to 3.19, p = 0.86), length of stay in the ICU (MD 0.04 days; 95% CI, -0.79 to 0.87, p = 0.92), duration of mechanical ventilation (MD -0.38 days; 95% CI, -1.48 to 0.72, p = 0.50), but was associated with an increased risk of hospital-acquired pneumonia (RR 1.53; 95% CI, 1.04 to 2.27; p = 0.03). Our results suggested that in patients receiving enteral feeding, pharmacologic SUP is not beneficial and combined interventions may even increase the risk of nosocomial pneumonia.