Cochrane · systematic review · CD008687
Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Toews, I, George, AT, Peter, JV, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
GutAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
54
current version
GRADE rated
41
No studies
13
Included studies
NR
No studies 13 · 24.1%Ungraded 0 · 0%Very low 2 · 3.7%Low 31 · 57.4%Moderate 8 · 14.8%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Interventions compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding Interventions vs placebo or no prophylaxis | RR 0.47 [0.39, 0.57] | 30 studies · 3207 participants | Moderate Downgraded: risk of bias, imprecision |
Nosocomial pneumonia Interventions vs placebo or no prophylaxis | RR 1.15 [0.9, 1.48] | 9 studies · 1331 participants | Low Downgraded: risk of bias, imprecision |
All‐cause mortality in ICU Interventions vs placebo or no prophylaxis | RR 1.1 [0.9, 1.34] | 19 studies · 2159 participants | Low Downgraded: risk of bias, imprecision |
Duration of ICU stay Interventions vs placebo or no prophylaxis | no estimate extracted | 2 studies · 447 participants | Low Downgraded: risk of bias, imprecision |
Number of participants requiring blood transfusion Interventions vs placebo or no prophylaxis | RR 0.63 [0.41, 0.97] | 9 studies · 981 participants | Moderate Downgraded: risk of bias, imprecision |
Serious adverse events Interventions vs placebo or no prophylaxis | no estimate extracted | NR | No studies |
H2 receptor antagonists compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding H2 receptor antagonists vs placebo or no prophylaxis | RR 0.5 [0.36, 0.7] | 24 studies · 2149 participants | Moderate Downgraded: risk of bias, imprecision |
Nosocomial pneumonia H2 receptor antagonists vs placebo or no prophylaxis | RR 1.12 [0.85, 1.48] | 8 studies · 945 participants | Low Downgraded: risk of bias, imprecision |
All‐cause mortality in ICU H2 receptor antagonists vs placebo or no prophylaxis | RR 1.12 [0.88, 1.42] | 14 studies · 1428 participants | Low Downgraded: risk of bias, imprecision |
Duration of ICU stay H2 receptor antagonists vs placebo or no prophylaxis | no estimate extracted | 2 studies · 230 participants | Low Downgraded: risk of bias, imprecision |
Number of participants requiring blood transfusions H2 receptor antagonists vs placebo or no prophylaxis | RR 0.58 [0.36, 0.95] | 7 studies · 655 participants | Moderate Downgraded: risk of bias, imprecision |
Serious adverse events H2 receptor antagonists vs placebo or no prophylaxis | no estimate extracted | NR | No studies |
Proton pump inhibitors compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding Proton pump inhibitors vs placebo or no prophylaxis | RR 0.63 [0.18, 2.22] | 3 studies · 237 participants | Low Downgraded: imprecision |
Nosocomial pneumonia Proton pump inhibitors vs placebo or no prophylaxis | RR 1.24 [0.77, 1.98] | 2 studies · 227 participants | Low Downgraded: imprecision |
All‐cause mortality in ICU Proton pump inhibitors vs placebo or no prophylaxis | RR 1.09 [0.6, 1.99] | 3 studies · 258 participants | Low Downgraded: imprecision |
Duration of ICU stay Proton pump inhibitors vs placebo or no prophylaxis | no estimate extracted | 2 studies · 227 participants | Low Downgraded: imprecision |
Number of participants requiring blood transfusion Proton pump inhibitors vs placebo or no prophylaxis | no estimate extracted | NR | No studies |
Serious adverse events Proton pump inhibitors vs placebo or no prophylaxis | no estimate extracted | NR | No studies |
Antacids compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding Antacids vs placebo or no prophylaxis | RR 0.49 [0.25, 0.99] | 8 studies · 774 participants | Low Downgraded: inconsistency |
Nosocomial pneumonia Antacids vs placebo or no prophylaxis | no estimate extracted | NR | No studies |
All‐cause mortality in ICU Antacids vs placebo or no prophylaxis | RR 1.01 [0.53, 1.96] | 2 studies · 300 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Duration of ICU stay Antacids vs placebo or no prophylaxis | no estimate extracted | NR | No studies |
Number of participants requiring blood transfusions Antacids vs placebo or no prophylaxis | RR 0.94 [0.3, 2.96] | 2 studies · 226 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Serious adverse events Antacids vs placebo or no prophylaxis | no estimate extracted | NR | No studies |
Sucralfate compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding Sucralfate vs placebo or no prophylaxis | RR 0.53 [0.32, 0.88] | 7 studies · 598 participants | Moderate Downgraded: risk of bias, imprecision |
Nosocomial pneumonia Sucralfate vs placebo or no prophylaxis | RR 1.33 [0.86, 2.04] | 4 studies · 450 participants | Low Downgraded: risk of bias, imprecision |
All‐cause mortality in ICU Sucralfate vs placebo or no prophylaxis | RR 0.97 [0.66, 1.43] | 5 studies · 500 participants | Low Downgraded: risk of bias, imprecision |
Duration of ICU stay Sucralfate vs placebo or no prophylaxis | no estimate extracted | 2 studies · 224 participants | Low Downgraded: risk of bias, imprecision |
Number of participants requiring blood transfusion Sucralfate vs placebo or no prophylaxis | RR 0.6 [0.15, 2.44] | 1 study · 200 participants | Low Downgraded: risk of bias, imprecision |
Serious adverse events Sucralfate vs placebo or no prophylaxis | no estimate extracted | NR | No studies |
H2 receptor antagonists compared with proton pump inhibitors for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding H2 receptor antagonists vs proton pump inhibitors | RR 2.9 [1.83, 4.58] | 13 studies · 1636 participants | Low Downgraded: inconsistency |
Nosocomial pneumonia H2 receptor antagonists vs proton pump inhibitors | RR 1.02 [0.77, 1.35] | 10 studies · 1256 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
All‐cause mortality in ICU H2 receptor antagonists vs proton pump inhibitors | RR 0.96 [0.78, 1.19] | 12 studies · 1564 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Duration of ICU stay H2 receptor antagonists vs proton pump inhibitors | no estimate extracted | 5 studies · 482 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Number of participants requiring blood transfusion H2 receptor antagonists vs proton pump inhibitors | RR 1.98 [0.75, 5.21] | 3 studies · 575 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Serious adverse events H2 receptor antagonists vs proton pump inhibitors | no estimate extracted | NR | No studies |
H2 receptor antagonists compared with antacids for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding H2 receptor antagonists vs antacids | RR 0.96 [0.67, 1.36] | 16 studies · 1700 participants | Low Downgraded: imprecision |
Nosocomial pneumonia H2 receptor antagonists vs antacids | RR 1.05 [0.81, 1.36] | 4 studies · 581 participants | Low Downgraded: imprecision |
All‐cause mortality in ICU H2 receptor antagonists vs antacids | RR 1.01 [0.66, 1.55] | 11 studies · 1321 participants | Very low Downgraded: imprecision |
Duration of ICU stay H2 receptor antagonists vs antacids | no estimate extracted | NR | No studies |
Number of participants requiring blood transfusion H2 receptor antagonists vs antacids | RR 2.49 [1.35, 4.62] | 6 studies · 744 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Serious adverse events H2 receptor antagonists vs antacids | no estimate extracted | NR | No studies |
H2 receptor antagonists compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding H2 receptor antagonists vs sucralfate | RR 1.1 [0.87, 1.41] | 24 studies · 3316 participants | Low Downgraded: imprecision |
Nosocomial pneumonia H2 receptor antagonists vs sucralfate | RR 1.22 [1.07, 1.4] | 17 studies · 3041 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
All‐cause mortality in ICU H2 receptor antagonists vs sucralfate | RR 1.09 [0.95, 1.24] | 21 studies · 3178 participants | Low Downgraded: imprecision |
Duration of ICU stay H2 receptor antagonists vs sucralfate | no estimate extracted | 6 studies · 1791 participants | Very low Downgraded: imprecision |
Number of participants requiring blood transfusion H2 receptor antagonists vs sucralfate | RR 1.25 [0.7, 2.23] | 9 studies · 1095 participants | Low Downgraded: imprecision |
Serious adverse events H2 receptor antagonists vs sucralfate | no estimate extracted | NR | No studies |
Antacids compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Population: people admitted to intensive care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinically important upper GI bleeding Antacids vs sucralfate | RR 1 [0.72, 1.39] | 16 studies · 1772 participants | Low Downgraded: imprecision |
Nosocomial pneumonia Antacids vs sucralfate | RR 1.04 [0.84, 1.3] | 7 studies · 996 participants | Low Downgraded: imprecision |
All‐cause mortality in ICU Antacids vs sucralfate | RR 1.15 [0.93, 1.4] | 11 studies · 1249 participants | Low Downgraded: imprecision |
Duration of ICU stay Antacids vs sucralfate | no estimate extracted | 2 studies · 227 participants | Low Downgraded: imprecision |
Number of participants requiring blood transfusion Antacids vs sucralfate | RR 0.73 [0.4, 1.34] | 6 studies · 667 participants | Low Downgraded: imprecision |
Serious adverse events Antacids vs sucralfate | no estimate extracted | NR | No studies |