Stress ulcer prophylaxis versus placebo or no prophylaxis in adult hospitalised acutely ill patients—protocol for a systematic review with meta-analysis and trial sequential analysisReportar como inadecuado




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Systematic Reviews

, 6:118

First Online: 24 June 2017Received: 26 January 2017Accepted: 01 June 2017DOI: 10.1186-s13643-017-0509-4

Cite this article as: Marker, S., Perner, A., Wetterslev, J. et al. Syst Rev 2017 6: 118. doi:10.1186-s13643-017-0509-4

Abstract

BackgroundStress ulcer prophylaxis is considered standard of care in many critically ill patients in the intensive care unit ICU. However, the quality of evidence supporting this has recently been questioned, and clinical equipoise exists. Whether there is overall benefit or harm of stress ulcer prophylaxis in adult hospitalised acutely ill patients is unknown. Accordingly, we aim to assess patient-important benefits and harms of stress ulcer prophylaxis versus placebo or no treatment in adult hospitalised acutely ill patients with high risk of gastrointestinal bleeding irrespective of hospital setting.

Methods-designWe will conduct a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis and assess use of proton pump inhibitors PPIs or histamine-2-receptor antagonists H2RAs in any dose, formulation and duration. We will accept placebo or no prophylaxis as control interventions. The participants will be adult hospitalised acutely ill patients with high risk of gastrointestinal bleeding.

We will systematically search the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS and Epistemonikos for relevant literature. We will follow the recommendations by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta-Analysis PRISMA statement. The risk of systematic errors bias and random errors will be assessed, and the overall quality of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation GRADE approach.

DiscussionThere is a need for a high-quality systematic review to summarise the benefits and harms of stress ulcer prophylaxis in hospitalised patients to inform practice and future research. Although stress ulcer prophylaxis is used worldwide, no firm evidence for benefit or harm as compared to placebo or no treatments has been established. Critical illness is a continuum not limited to the ICU setting, which is why it is important to assess the benefits and harms of stress ulcer prophylaxis in a wider perspective than exclusively in ICU patients.

Systematic review registrationPROSPERO CRD42017055676

KeywordsAcid suppressants Gastrointestinal bleeding Risk factors Side effects Stress ulcer prophylaxis Proton pump inhibitors Histamine-2-receptor antagonists AbbreviationsAKIAcute kidney injury

ATPaseAdenosine Triphosphatase

CIConfidence interval

FWERFamily wise error rate

H2RAHistamine-2-receptor antagonist

ICUIntensive care unit

MDMean difference

NCBINational Center for Biotechnology Information

PPIProton pump inhibitor

PRISMA-PPreferred Reporting Items for Systematic Review and Meta-Analysis Protocols

PROSPEROInternational Prospective Register of Systematic Reviews

RCTRandomised clinical trial

RRRelative risk

SAESerious adverse event

SDStandard deviation

SUP-ICUStress Ulcer Prophylaxis in the Intensive Care Unit

TSATrial sequential analysis

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s13643-017-0509-4 contains supplementary material, which is available to authorized users.





Autor: Søren Marker - Anders Perner - Jørn Wetterslev - Marija Barbateskovic - Janus Christian Jakobsen - Mette Krag - Anders G

Fuente: https://link.springer.com/







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