Mustafa Alquraini1, Fayez Alshamsi2, Morten Hylander Møller3, Emilie Belley-Cote4, Saleh Almenawer5, Roman Jaeschke6, Robert MacLaren7, Waleed Alhazzani8. 1. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada. 2. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada; Department of Internal Medicine, College of Medicine & Health Sciences, UAE University, PO Box 17666, United Arab Emirates. Electronic address: fayez.alshamsi@medportal.ca. 3. Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 4. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S 4K1, Canada. Electronic address: emilie.belley-cote@medportal.ca. 5. Department of Neurosurgery, McMaster University, Hamilton, On L8l 2X2, Canada. 6. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S 4K1, Canada. Electronic address: jaeschke@mcmaster.ca. 7. Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA. Electronic address: Rob.MacLaren@ucdenver.edu. 8. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S 4K1, Canada. Electronic address: alhazzaw@mcmaster.ca.
Abstract
PURPOSE: To determine the impact of using sucralfate versus H2RAs for SUP on patient important outcomes. MATERIALS AND METHODS: We searched CENTRAL, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through June 2016 for randomized controlled trials (RCTs) comparing sucralfate to H2RAs for SUP in adult critically ill patients. RESULTS: 21 RCTs enrolling 3121 patients met inclusion criteria. There was no significant difference between sucralfate compared to H2RAs in the risk of clinically important GI bleeding (risk ratio [RR] 1.19; 95% CI [confidence interval] 0.79, 1.80; P=0.42; I2=0%; low quality evidence). However, there was a statistically significant lower risk of ICU acquired pneumonia with sucralfate compared to H2RAs (RR 0.84; 95% CI 0.72, 0.98; P=0.03; I2=0%; moderate quality evidence). Sucralfate did not significantly affect the risk of death (RR 0.95; 95% CI 0.82, 1.10; P=0.51; I2=0%; high quality evidence), or duration of ICU stay in days (mean difference-0.39; 95% CI [-1.12, 0.34]; P=0.29; I2=0%; moderate quality evidence). Trial sequential analysis adjusted estimates were consistent with conventional estimates. CONCLUSION: Moderate quality evidence suggests that sucralfate reduced ICU acquired pneumonia compared to H2RAs in adult critically ill patients, with no significant impact on GI bleeding or death.
PURPOSE: To determine the impact of using sucralfate versus H2RAs for SUP on patient important outcomes. MATERIALS AND METHODS: We searched CENTRAL, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through June 2016 for randomized controlled trials (RCTs) comparing sucralfate to H2RAs for SUP in adult critically ill patients. RESULTS: 21 RCTs enrolling 3121 patients met inclusion criteria. There was no significant difference between sucralfate compared to H2RAs in the risk of clinically important GI bleeding (risk ratio [RR] 1.19; 95% CI [confidence interval] 0.79, 1.80; P=0.42; I2=0%; low quality evidence). However, there was a statistically significant lower risk of ICU acquired pneumonia with sucralfate compared to H2RAs (RR 0.84; 95% CI 0.72, 0.98; P=0.03; I2=0%; moderate quality evidence). Sucralfate did not significantly affect the risk of death (RR 0.95; 95% CI 0.82, 1.10; P=0.51; I2=0%; high quality evidence), or duration of ICU stay in days (mean difference-0.39; 95% CI [-1.12, 0.34]; P=0.29; I2=0%; moderate quality evidence). Trial sequential analysis adjusted estimates were consistent with conventional estimates. CONCLUSION: Moderate quality evidence suggests that sucralfate reduced ICU acquired pneumonia compared to H2RAs in adult critically ill patients, with no significant impact on GI bleeding or death.
Authors: Ingrid Toews; Aneesh Thomas George; John V Peter; Richard Kirubakaran; Luís Eduardo S Fontes; Jabez Paul Barnabas Ezekiel; Joerg J Meerpohl Journal: Cochrane Database Syst Rev Date: 2018-06-04