title: Stress ulcer prophylaxis in the intensive care unit: is it indicated? A topical systematic review.
abstract: Stress ulcer prophylaxis (SUP) is regarded as standard of care in the intensive care unit (ICU). However, recent randomized, clinical trials (RCTs) and meta-analyses have questioned the rationale and level of evidence for this recommendation. The aim of the present systematic review was to evaluate if SUP in the critically ill patients is indicated.
  
  
  METHODS
  MEDLINE including MeSH, EMBASE, and the Cochrane Library.
  
  
  METHODS
  patients in the ICU.
  
  
  METHODS
  pharmacological and non-pharmacological SUP.
  
  
  METHODS
  Risk of bias was assessed according to Grading of Recommendations Assessment, Development, and Evaluation, and risk of random errors in cumulative meta-analyses was assessed with trial sequential analysis. A total of 57 studies were included in the review. The literature on SUP in the ICU includes limited trial data and methodological weak studies. The reported incidence of gastrointestinal (GI) bleeding varies considerably. Data on the incidence and severity of GI bleeding in general ICUs in the developed world as of today are lacking. The best intervention for SUP is yet to be settled by balancing efficacy and harm. In essence, it is unresolved if intensive care patients benefit overall from SUP. The following clinically research questions are unanswered: (1) What is the incidence of GI bleeding, and which interventions are used for SUP in general ICUs today?; (2) Which criteria are used to prescribe SUP?; (3) What is the best SUP intervention?; (4) Do intensive care patients benefit from SUP with proton pump inhibitors as compared with other SUP interventions? Systematic reviews of possible interventions and well-powered observational studies and RCTs are needed.
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Krag
authors.forename: A
authors.initials: A
authors.lastname: Perner
authors.forename: J
authors.initials: J
authors.lastname: Wetterslev
authors.forename: M H
authors.initials: MH
authors.lastname: Møller
mesh_terms: D000863:Antacids / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000150:complications; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004750:Enteral Nutrition; D019317:Evidence-Based Medicine; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D015201:Meta-Analysis as Topic; D016595:Misoprostol / Q000627:therapeutic use; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D010437:Peptic Ulcer / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000517:prevention & control; D053717:Pneumonia, Ventilator-Associated / Q000150:complications; D017410:Practice Guidelines as Topic; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D013312:Stress, Physiological; D013392:Sucralfate / Q000627:therapeutic use
chemical_list: D000863:Antacids; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D016595:Misoprostol; D013392:Sucralfate