[Bleeding and pneumonia in intensive care unit patients given proton pump inhibitor or histamine-2 receptor antagonist for prevention of stress ulcer: a Meta analysis].
OBJECTIVE
To assess the efficacy and safety of proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H(2)RA) in intensive care unit patients for stress ulcer prophylaxis.


METHODS
A systematic search of MEDLINE (1966 to March 2009), Ebsco and CNKI was made. Two reviewers were assigned to assess the quality of studies and extracted data independently. Six items were evaluated for each trial (patient selection, patient characteristics, randomization, blinding, definition of bleeding and of pneumonia). Disagreements were resolved through discussion. RevMan 4.2.2 software developed by the cochrane collaboration was used for Meta-analysis.


RESULTS
Four series of clinical use involving 771 patients were included. Meta-analysis showed that the incidence of clinically significant bleeding was significantly lower in the PPI group (2.2% vs. 6.8%) as compared to H(2)RA group [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.21 to 0.96, P=0.04]. There was no significant difference of the incidence of nosocomial pneumonia (10.0% vs. 9.9%, OR 1.03, 95%CI 0.63 to 1.70, P=0.89) and mortality (14.5% vs. 14.3%,OR 1.17, 95%CI 0.76 to 1.80, P=0.47) between two groups.


CONCLUSIONS
In comparison with H(2)RA, PPI is more effective in the prevention of stress ulcer bleeding (SUB) in patients under intensive care. There is no significant difference in the incidence of nosocomial pneumonia and mortality between two groups. There were very few randomized controlled clinical trials on prevention of stress ulcer, and these findings were based on a small number of patients, therefore a steadfast conclusion cannot presently be reached. More randomized, multicenter studies with sufficient sample size are warranted.
Zhou
Jun-feng
JF
General Intensive Care Unit, the First Affiliated Hospital, Dalian Medical University, Dalian 116011, Liaoning, China.
Wan
Xian-yao
XY
Huang
Wei
W
Han
Li-li
LL
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors