Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2021 Mar;65(3):292-301. doi: 10.1111/aas.13731. Epub 2020 Nov 22.
Critically ill children are at risk of stress-induced gastrointestinal ulceration. Acid suppressants are frequently used in intensive care units even though there is uncertainty about the benefits and harms. With this systematic review, we aimed to assess patient-important benefits and harms of stress ulcer prophylaxis (SUP) in children in intensive care.
We conducted the review according to the PRISMA statement, the Cochrane Handbook, and GRADE, using conventional meta-analysis and trial sequential analysis (TSA). We included randomised clinical trials comparing SUP with histamine-2-receptor antagonists or proton pump inhibitors vs placebo/no prophylaxis in children admitted for intensive care. Primary outcomes were all-cause mortality and overt gastrointestinal bleeding. Secondary outcomes were serious adverse events, hospital-acquired pneumonia, Clostridium difficile enteritis, myocardial ischemia, acute kidney injury and quality of life.
We included a total of seven trials (n = 504) with eight trial comparisons. We found no statistically significant difference in all-cause mortality (relative risk (RR) 1.43, 95% confidence interval (CI) 0.86-2.37), overt gastrointestinal bleeding (RR 0.75, 95% CI 0.42-1.35) or hospital-acquired pneumonia (RR 1.18, 95% CI 0.77-1.82) between SUP vs placebo/no prophylaxis. No trials reported on remaining secondary outcomes. TSA was unable to draw firm conclusions for all outcomes and certainty of evidence for all outcomes was "very low."
We found no difference in all-cause mortality, overt gastrointestinal bleeding or hospital-acquired pneumonia in children in intensive care receiving acid suppressants compared with placebo/no prophylaxis. However, the quantity and quality of evidence was very low with no firm evidence for benefit or harm.
危重症患儿存在应激性胃肠溃疡的风险。抑酸剂经常在重症监护病房使用，尽管其获益和危害并不明确。本系统评价旨在评估重症监护患儿应激性溃疡预防（SUP）的患者重要获益和危害。
我们按照 PRISMA 声明、 Cochrane 手册和 GRADE 进行综述，采用常规荟萃分析和试验序贯分析（TSA）。我们纳入了比较 SUP 与组胺 2 受体拮抗剂或质子泵抑制剂与安慰剂/无预防措施在重症监护病房入院患儿中的随机临床试验。主要结局为全因死亡率和显性胃肠道出血。次要结局为严重不良事件、医院获得性肺炎、艰难梭菌肠炎、心肌缺血、急性肾损伤和生活质量。
我们共纳入了 7 项试验（n=504），共 8 项试验比较。我们发现 SUP 与安慰剂/无预防措施相比，全因死亡率（相对风险（RR）1.43，95%置信区间（CI）0.86-2.37）、显性胃肠道出血（RR 0.75，95% CI 0.42-1.35）或医院获得性肺炎（RR 1.18，95% CI 0.77-1.82）无统计学差异。没有试验报告其余次要结局。TSA 无法对所有结局得出确定结论，所有结局的证据确定性均为“极低”。
与安慰剂/无预防措施相比，重症监护患儿使用抑酸剂并未降低全因死亡率、显性胃肠道出血或医院获得性肺炎的发生风险。但是，证据的数量和质量非常低，没有关于获益或危害的可靠证据。
