Toews Ingrid, Hussain Salman, Nyirenda John L Z, Willis Maria A, Kantorová Lucia, Slezáková Simona, Boltena Minyahil Tadesse, Peter John Victor, Fontes Luis Eduardo Santos, Klugar Miloslav, Sadeghirad Behnam, Meerpohl Joerg J
Institute for Evidence in Medicine, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
BMJ Evid Based Med. 2025 Jan 22;30(1):22-35. doi: 10.1136/bmjebm-2024-112886.
To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs).
Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.
Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included.
The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP).
The primary outcome was the prevention of clinically important upper GI bleeding.
We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding.The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.
Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients' underlying conditions.
评估药物干预措施对预防重症监护病房（ICU）患者上消化道（GI）出血的有效性和安全性。
采用Cochrane推荐的标准方法程序进行系统评价和频率学派网状Meta分析，以筛选记录、提取数据和进行分析。使用推荐分级评估、制定与评价（GRADE）方法评估证据的确定性。
纳入涉及入住ICU超过24小时患者的随机对照试验。
检索了2017年8月至2022年3月的Cochrane肠道专业注册库、Cochrane对照试验中央注册库（CENTRAL）、MEDLINE、Embase以及拉丁美洲和加勒比健康科学信息数据库（LILACS）。MEDLINE的检索于2023年4月更新。我们还检索了ClinicalTrials.gov和世界卫生组织国际临床试验注册平台（WHO ICTRP）。
主要结局是预防具有临床意义的上消化道出血。
我们纳入了123项研究，共46996名参与者。西咪替丁（相对风险（RR）0.56，95%置信区间0.40至0.77，中等确定性）、雷尼替丁（RR 0.54，95%置信区间0.38至0.76，中等确定性）、抗酸剂（RR 0.48，95%置信区间0.33至0.68，中等确定性）、硫糖铝（RR 0.54，95%置信区间0.39至0.75，中等确定性）以及雷尼替丁与抗酸剂的联合使用（RR 上消化道出血。任何干预措施对预防医院获得性肺炎、ICU或医院的全因死亡率、在ICU的住院时间、插管时间以及（严重）不良事件的影响仍不明确。
几种干预措施似乎对预防具有临床意义的上消化道出血有效，而其他结局的证据有限。需要根据患者的基础疾病评估与患者相关的获益和危害。
