Pharmacological interventions for preventing upper
gastrointestinal bleeding in people admitted to intensive care
units: a network meta-analysis

J 2024

Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis

TOEWS, Ingrid, Mohammad Salman HUSSAIN, John L Z NYIRENDA, Maria A WILLIS, Lucia HASONOVÁ et. al.

Základní údaje

Originální název

Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis

Autoři

Vydání

BMJ EVIDENCE-BASED MEDICINE, London, BMJ PUBLISHING GROUP, 2024, 2515-446X

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Stát vydavatele

Velká Británie a Severní Irsko

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 5.800 v roce 2022

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.1136/bmjebm-2024-112886

UT WoS

001270955700001

Klíčová slova anglicky

Systematic Reviews as Topic; Drug-Related Side Effects and Adverse Reactions; Gastrointestinal Diseases; Hematology

Štítky

14119612, 14119613

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 5. 8. 2024 10:10, Mgr. Tereza Miškechová

Anotace

V originále

Objectives To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs).Design and setting Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.Participants Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included.Search methods The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP).Main outcome measures The primary outcome was the prevention of clinically important upper GI bleeding.Results We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding. The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.Results We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding. The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.Conclusions Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients' underlying conditions.

Citovat

TOEWS, Ingrid, Mohammad Salman HUSSAIN, John L Z NYIRENDA, Maria A WILLIS, Lucia HASONOVÁ, Simona SLEZAKOVA, Minyahil Tadesse BOLTENA, Peter John VICTOR, Luis Eduardo Santos FONTES, Miloslav KLUGAR, Behnam SADEGHIRAD a Joerg J MEERPOHL. Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis. BMJ EVIDENCE-BASED MEDICINE. London: BMJ PUBLISHING GROUP, 2024, 14 s. ISSN 2515-446X. Dostupné z: https://dx.doi.org/10.1136/bmjebm-2024-112886.

@article{2421663,
   author = {Toews, Ingrid and Hussain, Mohammad Salman and Nyirenda, John L Z and Willis, Maria A and Hasonová, Lucia and Slezakova, Simona and Boltena, Minyahil Tadesse and Victor, Peter John and Fontes, Luis Eduardo Santos and Klugar, Miloslav and Sadeghirad, Behnam and Meerpohl, Joerg J},
   article_location = {London},
   doi = {http://dx.doi.org/10.1136/bmjebm-2024-112886},
   keywords = {Systematic Reviews as Topic; Drug-Related Side Effects and Adverse Reactions; Gastrointestinal Diseases; Hematology},
   language = {eng},
   issn = {2515-446X},
   journal = {BMJ EVIDENCE-BASED MEDICINE},
   title = {Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis},
   url = {https://ebm.bmj.com/content/early/2024/07/26/bmjebm-2024-112886},
   year = {2024}
}

TY  - JOUR
ID  - 2421663
AU  - Toews, Ingrid - Hussain, Mohammad Salman - Nyirenda, John L Z - Willis, Maria A - Hasonová, Lucia - Slezakova, Simona - Boltena, Minyahil Tadesse - Victor, Peter John - Fontes, Luis Eduardo Santos - Klugar, Miloslav - Sadeghirad, Behnam - Meerpohl, Joerg J
PY  - 2024
TI  - Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis
JF  - BMJ EVIDENCE-BASED MEDICINE
PB  - BMJ PUBLISHING GROUP
SN  - 2515446X
KW  - Systematic Reviews as Topic
KW  - Drug-Related Side Effects and Adverse Reactions
KW  - Gastrointestinal Diseases
KW  - Hematology
UR  - https://ebm.bmj.com/content/early/2024/07/26/bmjebm-2024-112886
N2  - Objectives To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs).Design and setting Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.Participants Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included.Search methods The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP).Main outcome measures The primary outcome was the prevention of clinically important upper GI bleeding.Results We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding. The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.Results We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding. The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.Conclusions Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients' underlying conditions.
ER  -

TOEWS, Ingrid, Mohammad Salman HUSSAIN, John L Z NYIRENDA, Maria A WILLIS, Lucia HASONOVÁ, Simona SLEZAKOVA, Minyahil Tadesse BOLTENA, Peter John VICTOR, Luis Eduardo Santos FONTES, Miloslav KLUGAR, Behnam SADEGHIRAD a Joerg J MEERPOHL. Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis. \textit{BMJ EVIDENCE-BASED MEDICINE}. London: BMJ PUBLISHING GROUP, 2024, 14 s. ISSN~2515-446X. Dostupné z: https://dx.doi.org/10.1136/bmjebm-2024-112886.

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