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Cochrane Database of Systematic Reviews

Intervenciones para la prevención de la hemorragia digestiva alta en pacientes ingresados a la unidad de cuidados intensivos

Información

DOI:
https://doi.org/10.1002/14651858.CD008687.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 04 junio 2018see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Salud digestiva

Copyright:
  1. Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Ingrid Toews

    Evidence in Medicine / Cochrane Germany, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

  • Aneesh Thomas George

    Cochrane South Asia, Prof. BV Moses Centre for Evidence‐Informed Healthcare and Health Policy, Christian Medical College, Vellore, India

  • John V Peter

    Medical Intensive Care Unit, Christian Medical College & Hospital, Vellore, India

  • Richard Kirubakaran

    Cochrane South Asia, Prof. BV Moses Centre for Evidence‐Informed Healthcare and Health Policy, Christian Medical College, Vellore, India

  • Luís Eduardo S Fontes

    Department of Evidence‐Based Medicine, Intensive Care, Gastroenterology, Petrópolis Medical School, Petrópolis, Brazil

  • Jabez Paul Barnabas Ezekiel

    Cochrane South Asia, Prof. BV Moses Centre for Evidence‐Informed Healthcare and Health Policy, Christian Medical College, Vellore, India

  • Joerg J Meerpohl

    Correspondencia a: Evidence in Medicine / Cochrane Germany, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    [email protected]

    [email protected]

Contributions of authors

Ingrid Toews: searching for additional references, selecting studies, extracting data, assessing quality, locating and retrieving full‐text articles, refining and updating the review, and writing and approving the final version of the review.

Aneesh Thomas George: developing and drafting the initial version of the protocol, searching for additional references, and approving the final version of the protocol and the review.

John Victor Peter: conceptualising the review topic, developing the protocol, providing citations and full‐text articles for the background, refining the review, and approving the final version.

Richard Kirubakaran: developing the protocol and approving the final version of the protocol.

Jabez Paul Barnabas: locating and retrieving full‐text articles and approving the final version of the protocol.

Luis Eduardo S Fontes: performing study selection, data extraction, and quality assessment; locating and retrieving full‐text articles; refining and updating the review; and writing the Authors' Conclusions section.

Joerg Meerpohl: performing study selection, locating and retrieving full‐text articles, and refining and approving the final version of the review.

Sources of support

Internal sources

  • South Asian Cochrane Centre, India.

    Employment and training of Dr. George, Mr. Kirubakaran and Mr. Barnabas

External sources

  • Indian Council of Medical Research, New Delhi, India.

    Funding for staff and activities of the South Asian Cochrane Centre

  • Christian Medical College, Vellore, India.

    Salary of Drs. Tharyan and Peter; logistic support for the South Asian Cochrane Centre

Declarations of interest

All review authors declare no conflict academic or financial interests that will influence the conduct, interpretation, or reporting of this review.

Acknowledgements

The first draft of this document was the output of a workshop organised by the South Asian Cochrane Network at Christian Medical College, in Vellore, India. Prathap Tharyan also contributed considerably to the first draft of this review.

Hsiu‐Han Chan co‐ordinated data extraction and quality assessment for three included studies that are published in the Chinese language. Yang‐Sheng Lin, MD, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, Taiwan; and Sheng‐Wei Cheng, Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan extracted data from three studies using the Chinese language.

Cathy Yuan conducted literature searches for the review update in June 2016 and August 2017.

Version history

Published

Title

Stage

Authors

Version

2018 Jun 04

Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Review

Ingrid Toews, Aneesh Thomas George, John V Peter, Richard Kirubakaran, Luís Eduardo S Fontes, Jabez Paul Barnabas Ezekiel, Joerg J Meerpohl

https://doi.org/10.1002/14651858.CD008687.pub2

2010 Sep 08

Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Protocol

Aneesh Thomas George, Prathap Tharyan, John V Peter, Richard Kirubakaran, Jabez Paul Barnabas

https://doi.org/10.1002/14651858.CD008687

Differences between protocol and review

The number of participants requiring more than two units of blood was changed to not define the number of units transfused.

The outcome 'ventilator‐associated pneumonia' was changed to 'nosocomial pneumonia including ventilator‐associated pneumonia' because definitions varied across study reports.

'Potassium‐competitive acid blockers' was added to list of eligible interventions.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

PRISMA flow chart of included studies.
Figuras y tablas -
Figure 1

PRISMA flow chart of included studies.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Funnel plot of comparison: 1 Interventions versus placebo or no prophylaxis, outcome: 1.1 Clinically important upper GI bleeding.
Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Interventions versus placebo or no prophylaxis, outcome: 1.1 Clinically important upper GI bleeding.

Funnel plot of comparison: 2 H2 receptor antagonists versus placebo or no prophylaxis, outcome: 2.1 Clinically important upper GI bleeding.
Figuras y tablas -
Figure 5

Funnel plot of comparison: 2 H2 receptor antagonists versus placebo or no prophylaxis, outcome: 2.1 Clinically important upper GI bleeding.

Funnel plot of comparison: 9 H2 receptor antagonists versus proton pump inhibitors, outcome: 9.1 Clinically important upper GI bleeding.
Figuras y tablas -
Figure 6

Funnel plot of comparison: 9 H2 receptor antagonists versus proton pump inhibitors, outcome: 9.1 Clinically important upper GI bleeding.

Funnel plot of comparison: 10 H2 receptor antagonists versus antacids, outcome: 10.1 Clinically important upper GI bleeding.
Figuras y tablas -
Figure 7

Funnel plot of comparison: 10 H2 receptor antagonists versus antacids, outcome: 10.1 Clinically important upper GI bleeding.

Funnel plot of comparison: 11 H2 receptor antagonists versus sucralfate, outcome: 11.1 Clinically important upper GI bleeding.
Figuras y tablas -
Figure 8

Funnel plot of comparison: 11 H2 receptor antagonists versus sucralfate, outcome: 11.1 Clinically important upper GI bleeding.

Funnel plot of comparison: 19 Antacids versus sucralfate, outcome: 19.1 Clinically important upper GI bleeding.
Figuras y tablas -
Figure 9

Funnel plot of comparison: 19 Antacids versus sucralfate, outcome: 19.1 Clinically important upper GI bleeding.

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 1.1

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 1.2

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 1.3

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 1.4

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 4 All‐cause mortality in hospital.

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 5 Duration of ICU stay.
Figuras y tablas -
Analysis 1.5

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 5 Duration of ICU stay.

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 6 Duration of intubation.
Figuras y tablas -
Analysis 1.6

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 6 Duration of intubation.

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 7 Number of participants requiring blood transfusions.
Figuras y tablas -
Analysis 1.7

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 7 Number of participants requiring blood transfusions.

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 8 Units of blood transfused.
Figuras y tablas -
Analysis 1.8

Comparison 1 Interventions versus placebo or no prophylaxis, Outcome 8 Units of blood transfused.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 2.1

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 2.2

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 2.3

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 2.4

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 4 All‐cause mortality in hospital.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 5 Duration of ICU stay.
Figuras y tablas -
Analysis 2.5

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 5 Duration of ICU stay.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 6 Duration of intubation.
Figuras y tablas -
Analysis 2.6

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 6 Duration of intubation.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 7 Number of participants requiring blood transfusions.
Figuras y tablas -
Analysis 2.7

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 7 Number of participants requiring blood transfusions.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 8 Units of blood transfused.
Figuras y tablas -
Analysis 2.8

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 8 Units of blood transfused.

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 9 Adverse events of interventions.
Figuras y tablas -
Analysis 2.9

Comparison 2 H2 receptor antagonists versus placebo or no prophylaxis, Outcome 9 Adverse events of interventions.

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 3.1

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 3.2

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 3.3

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 3.4

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 4 All‐cause mortality in hospital.

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 5 Duration of ICU stay.
Figuras y tablas -
Analysis 3.5

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 5 Duration of ICU stay.

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 6 Duration of intubation.
Figuras y tablas -
Analysis 3.6

Comparison 3 Proton pump inhibitors versus placebo or no prophylaxis, Outcome 6 Duration of intubation.

Comparison 4 Proton pump inhibitors + sucralfate versus no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 4.1

Comparison 4 Proton pump inhibitors + sucralfate versus no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 5 Prostaglandin analogues versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 5.1

Comparison 5 Prostaglandin analogues versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 5 Prostaglandin analogues versus placebo or no prophylaxis, Outcome 2 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 5.2

Comparison 5 Prostaglandin analogues versus placebo or no prophylaxis, Outcome 2 All‐cause mortality in ICU.

Comparison 6 Anticholinergics versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 6.1

Comparison 6 Anticholinergics versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 6 Anticholinergics versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 6.2

Comparison 6 Anticholinergics versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.

Comparison 6 Anticholinergics versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 6.3

Comparison 6 Anticholinergics versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 7.1

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 2 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 7.2

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 2 All‐cause mortality in ICU.

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 7.3

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in hospital.

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 4 Number of participants requiring blood transfusions.
Figuras y tablas -
Analysis 7.4

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 4 Number of participants requiring blood transfusions.

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 5 Adverse events of interventions.
Figuras y tablas -
Analysis 7.5

Comparison 7 Antacids versus placebo or no prophylaxis, Outcome 5 Adverse events of interventions.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 8.1

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 8.2

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 2 Nosocomial pneumonia.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 8.3

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 3 All‐cause mortality in ICU.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 8.4

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 4 All‐cause mortality in hospital.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 5 Duration of ICU stay.
Figuras y tablas -
Analysis 8.5

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 5 Duration of ICU stay.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 6 Duration of intubation.
Figuras y tablas -
Analysis 8.6

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 6 Duration of intubation.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 7 Number of participants requiring blood transfusions.
Figuras y tablas -
Analysis 8.7

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 7 Number of participants requiring blood transfusions.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 8 Units of blood transfused.
Figuras y tablas -
Analysis 8.8

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 8 Units of blood transfused.

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 9 Adverse events of interventions.
Figuras y tablas -
Analysis 8.9

Comparison 8 Sucralfate versus placebo or no prophylaxis, Outcome 9 Adverse events of interventions.

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 9.1

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 1 Clinically important upper GI bleeding.

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 9.2

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 2 Nosocomial pneumonia.

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 9.3

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 3 All‐cause mortality in ICU.

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 9.4

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 4 All‐cause mortality in hospital.

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 5 Duration of ICU stay.
Figuras y tablas -
Analysis 9.5

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 5 Duration of ICU stay.

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 6 Duration of intubation.
Figuras y tablas -
Analysis 9.6

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 6 Duration of intubation.

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 7 Number of participants requiring blood transfusions.
Figuras y tablas -
Analysis 9.7

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 7 Number of participants requiring blood transfusions.

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 8 Adverse events of interventions.
Figuras y tablas -
Analysis 9.8

Comparison 9 H2 receptor antagonists versus proton pump inhibitors, Outcome 8 Adverse events of interventions.

Comparison 10 H2 receptor antagonists versus antacids, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 10.1

Comparison 10 H2 receptor antagonists versus antacids, Outcome 1 Clinically important upper GI bleeding.

Comparison 10 H2 receptor antagonists versus antacids, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 10.2

Comparison 10 H2 receptor antagonists versus antacids, Outcome 2 Nosocomial pneumonia.

Comparison 10 H2 receptor antagonists versus antacids, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 10.3

Comparison 10 H2 receptor antagonists versus antacids, Outcome 3 All‐cause mortality in ICU.

Comparison 10 H2 receptor antagonists versus antacids, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 10.4

Comparison 10 H2 receptor antagonists versus antacids, Outcome 4 All‐cause mortality in hospital.

Comparison 10 H2 receptor antagonists versus antacids, Outcome 5 Duration of intubation.
Figuras y tablas -
Analysis 10.5

Comparison 10 H2 receptor antagonists versus antacids, Outcome 5 Duration of intubation.

Comparison 10 H2 receptor antagonists versus antacids, Outcome 6 Number of participants requiring blood transfusions.
Figuras y tablas -
Analysis 10.6

Comparison 10 H2 receptor antagonists versus antacids, Outcome 6 Number of participants requiring blood transfusions.

Comparison 10 H2 receptor antagonists versus antacids, Outcome 7 Adverse events of interventions.
Figuras y tablas -
Analysis 10.7

Comparison 10 H2 receptor antagonists versus antacids, Outcome 7 Adverse events of interventions.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 11.1

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 1 Clinically important upper GI bleeding.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 11.2

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 2 Nosocomial pneumonia.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 11.3

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 3 All‐cause mortality in ICU.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 11.4

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 4 All‐cause mortality in hospital.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 5 Duration of intubation.
Figuras y tablas -
Analysis 11.5

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 5 Duration of intubation.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 6 Duration of ICU stay.
Figuras y tablas -
Analysis 11.6

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 6 Duration of ICU stay.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 7 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 11.7

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 7 Number of participants requiring blood transfusion.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 8 Units of blood transfused.
Figuras y tablas -
Analysis 11.8

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 8 Units of blood transfused.

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 9 Adverse events of interventions.
Figuras y tablas -
Analysis 11.9

Comparison 11 H2 receptor antagonists versus sucralfate, Outcome 9 Adverse events of interventions.

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 12.1

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 1 Clinically important upper GI bleeding.

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 12.2

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 2 Nosocomial pneumonia.

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 12.3

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 3 All‐cause mortality in ICU.

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 4 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 12.4

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 4 Number of participants requiring blood transfusion.

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 5 Adverse events of interventions.
Figuras y tablas -
Analysis 12.5

Comparison 12 H2 receptor antagonists versus anticholinergics, Outcome 5 Adverse events of interventions.

Comparison 13 H2 receptor antagonists versus prostaglandin analogues, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 13.1

Comparison 13 H2 receptor antagonists versus prostaglandin analogues, Outcome 1 Clinically important upper GI bleeding.

Comparison 13 H2 receptor antagonists versus prostaglandin analogues, Outcome 2 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 13.2

Comparison 13 H2 receptor antagonists versus prostaglandin analogues, Outcome 2 All‐cause mortality in ICU.

Comparison 14 H2 receptor antagonists versus teprenone, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 14.1

Comparison 14 H2 receptor antagonists versus teprenone, Outcome 1 Clinically important upper GI bleeding.

Comparison 14 H2 receptor antagonists versus teprenone, Outcome 2 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 14.2

Comparison 14 H2 receptor antagonists versus teprenone, Outcome 2 All‐cause mortality in ICU.

Comparison 14 H2 receptor antagonists versus teprenone, Outcome 3 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 14.3

Comparison 14 H2 receptor antagonists versus teprenone, Outcome 3 Number of participants requiring blood transfusion.

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 15.1

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 1 Clinically important upper GI bleeding.

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 15.2

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 2 Nosocomial pneumonia.

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 15.3

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 3 All‐cause mortality in ICU.

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 4 Duration of ICU stay.
Figuras y tablas -
Analysis 15.4

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 4 Duration of ICU stay.

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 5 Duration of intubation.
Figuras y tablas -
Analysis 15.5

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 5 Duration of intubation.

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 6 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 15.6

Comparison 15 H2 receptor antagonist + antacids versus sucralfate, Outcome 6 Number of participants requiring blood transfusion.

Comparison 16 Proton pump inhibitors versus teprenone, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 16.1

Comparison 16 Proton pump inhibitors versus teprenone, Outcome 1 Clinically important upper GI bleeding.

Comparison 16 Proton pump inhibitors versus teprenone, Outcome 2 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 16.2

Comparison 16 Proton pump inhibitors versus teprenone, Outcome 2 All‐cause mortality in ICU.

Comparison 16 Proton pump inhibitors versus teprenone, Outcome 3 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 16.3

Comparison 16 Proton pump inhibitors versus teprenone, Outcome 3 Number of participants requiring blood transfusion.

Comparison 17 Proton pump inhibitor plus naloxone versus naloxone, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 17.1

Comparison 17 Proton pump inhibitor plus naloxone versus naloxone, Outcome 1 Clinically important upper GI bleeding.

Comparison 17 Proton pump inhibitor plus naloxone versus naloxone, Outcome 2 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 17.2

Comparison 17 Proton pump inhibitor plus naloxone versus naloxone, Outcome 2 All‐cause mortality in hospital.

Comparison 17 Proton pump inhibitor plus naloxone versus naloxone, Outcome 3 Adverse events ‐ gastrointestinal discomfort.
Figuras y tablas -
Analysis 17.3

Comparison 17 Proton pump inhibitor plus naloxone versus naloxone, Outcome 3 Adverse events ‐ gastrointestinal discomfort.

Comparison 18 Proton pump inhibitors versus other medication (not defined), Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 18.1

Comparison 18 Proton pump inhibitors versus other medication (not defined), Outcome 1 Clinically important upper GI bleeding.

Comparison 18 Proton pump inhibitors versus other medication (not defined), Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 18.2

Comparison 18 Proton pump inhibitors versus other medication (not defined), Outcome 2 Nosocomial pneumonia.

Comparison 18 Proton pump inhibitors versus other medication (not defined), Outcome 3 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 18.3

Comparison 18 Proton pump inhibitors versus other medication (not defined), Outcome 3 All‐cause mortality in hospital.

Comparison 19 Antacids versus sucralfate, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 19.1

Comparison 19 Antacids versus sucralfate, Outcome 1 Clinically important upper GI bleeding.

Comparison 19 Antacids versus sucralfate, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 19.2

Comparison 19 Antacids versus sucralfate, Outcome 2 Nosocomial pneumonia.

Comparison 19 Antacids versus sucralfate, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 19.3

Comparison 19 Antacids versus sucralfate, Outcome 3 All‐cause mortality in ICU.

Comparison 19 Antacids versus sucralfate, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 19.4

Comparison 19 Antacids versus sucralfate, Outcome 4 All‐cause mortality in hospital.

Comparison 19 Antacids versus sucralfate, Outcome 5 Duration of ICU stay.
Figuras y tablas -
Analysis 19.5

Comparison 19 Antacids versus sucralfate, Outcome 5 Duration of ICU stay.

Comparison 19 Antacids versus sucralfate, Outcome 6 Duration of intubation.
Figuras y tablas -
Analysis 19.6

Comparison 19 Antacids versus sucralfate, Outcome 6 Duration of intubation.

Comparison 19 Antacids versus sucralfate, Outcome 7 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 19.7

Comparison 19 Antacids versus sucralfate, Outcome 7 Number of participants requiring blood transfusion.

Comparison 19 Antacids versus sucralfate, Outcome 8 Adverse events of interventions.
Figuras y tablas -
Analysis 19.8

Comparison 19 Antacids versus sucralfate, Outcome 8 Adverse events of interventions.

Comparison 20 Antacids versus prostaglandin analogues, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 20.1

Comparison 20 Antacids versus prostaglandin analogues, Outcome 1 Clinically important upper GI bleeding.

Comparison 20 Antacids versus prostaglandin analogues, Outcome 2 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 20.2

Comparison 20 Antacids versus prostaglandin analogues, Outcome 2 All‐cause mortality in ICU.

Comparison 20 Antacids versus prostaglandin analogues, Outcome 3 Adverse events of interventions.
Figuras y tablas -
Analysis 20.3

Comparison 20 Antacids versus prostaglandin analogues, Outcome 3 Adverse events of interventions.

Comparison 21 Antacids versus bioflavonoids, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 21.1

Comparison 21 Antacids versus bioflavonoids, Outcome 1 Clinically important upper GI bleeding.

Comparison 21 Antacids versus bioflavonoids, Outcome 2 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 21.2

Comparison 21 Antacids versus bioflavonoids, Outcome 2 Number of participants requiring blood transfusion.

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 22.1

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 1 Clinically important upper GI bleeding.

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 22.2

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 2 Nosocomial pneumonia.

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 3 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 22.3

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 3 All‐cause mortality in ICU.

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 4 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 22.4

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 4 All‐cause mortality in hospital.

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 5 Duration of ICU stay.
Figuras y tablas -
Analysis 22.5

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 5 Duration of ICU stay.

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 6 Duration of intubation.
Figuras y tablas -
Analysis 22.6

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 6 Duration of intubation.

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 7 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 22.7

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 7 Number of participants requiring blood transfusion.

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 8 Adverse events of interventions.
Figuras y tablas -
Analysis 22.8

Comparison 22 Sucralfate versus proton pump inhibitors, Outcome 8 Adverse events of interventions.

Comparison 23 Sucralfate versus bioflavonoids, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 23.1

Comparison 23 Sucralfate versus bioflavonoids, Outcome 1 Clinically important upper GI bleeding.

Comparison 23 Sucralfate versus bioflavonoids, Outcome 2 Number of participants requiring blood transfusion.
Figuras y tablas -
Analysis 23.2

Comparison 23 Sucralfate versus bioflavonoids, Outcome 2 Number of participants requiring blood transfusion.

Comparison 24 Total parenteral nutrition (TPN) versus any other intervention + TPN, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 24.1

Comparison 24 Total parenteral nutrition (TPN) versus any other intervention + TPN, Outcome 1 Clinically important upper GI bleeding.

Comparison 24 Total parenteral nutrition (TPN) versus any other intervention + TPN, Outcome 2 All‐cause mortality in ICU.
Figuras y tablas -
Analysis 24.2

Comparison 24 Total parenteral nutrition (TPN) versus any other intervention + TPN, Outcome 2 All‐cause mortality in ICU.

Comparison 24 Total parenteral nutrition (TPN) versus any other intervention + TPN, Outcome 3 Duration of intubation.
Figuras y tablas -
Analysis 24.3

Comparison 24 Total parenteral nutrition (TPN) versus any other intervention + TPN, Outcome 3 Duration of intubation.

Comparison 25 Bowel stimulation versus no prophylaxis, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 25.1

Comparison 25 Bowel stimulation versus no prophylaxis, Outcome 1 Clinically important upper GI bleeding.

Comparison 26 Nasojejunal nutrition versus nasogastric nutrition, Outcome 1 Clinically important upper GI bleeding.
Figuras y tablas -
Analysis 26.1

Comparison 26 Nasojejunal nutrition versus nasogastric nutrition, Outcome 1 Clinically important upper GI bleeding.

Comparison 26 Nasojejunal nutrition versus nasogastric nutrition, Outcome 2 Nosocomial pneumonia.
Figuras y tablas -
Analysis 26.2

Comparison 26 Nasojejunal nutrition versus nasogastric nutrition, Outcome 2 Nosocomial pneumonia.

Comparison 26 Nasojejunal nutrition versus nasogastric nutrition, Outcome 3 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 26.3

Comparison 26 Nasojejunal nutrition versus nasogastric nutrition, Outcome 3 All‐cause mortality in hospital.

Comparison 26 Nasojejunal nutrition versus nasogastric nutrition, Outcome 4 Adverse events of interventions.
Figuras y tablas -
Analysis 26.4

Comparison 26 Nasojejunal nutrition versus nasogastric nutrition, Outcome 4 Adverse events of interventions.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 1 Nosocomial pneumonia.
Figuras y tablas -
Analysis 27.1

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 1 Nosocomial pneumonia.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 2 All‐cause mortality in hospital.
Figuras y tablas -
Analysis 27.2

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 2 All‐cause mortality in hospital.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 3 Duration of ICU stay.
Figuras y tablas -
Analysis 27.3

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 3 Duration of ICU stay.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 4 Duration of intubation.
Figuras y tablas -
Analysis 27.4

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 4 Duration of intubation.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 5 Adverse events ‐ stress ulcer.
Figuras y tablas -
Analysis 27.5

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 5 Adverse events ‐ stress ulcer.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 6 Adverse events ‐ diarrhoea.
Figuras y tablas -
Analysis 27.6

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 6 Adverse events ‐ diarrhoea.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 7 Adverse events ‐ pyaemia.
Figuras y tablas -
Analysis 27.7

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 7 Adverse events ‐ pyaemia.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 8 Adverse events ‐ intracranial infection.
Figuras y tablas -
Analysis 27.8

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 8 Adverse events ‐ intracranial infection.

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 9 Adverse events ‐ hypoproteinaemia.
Figuras y tablas -
Analysis 27.9

Comparison 27 Enteral plus parenteral nutrition versus other nutrition regimens, Outcome 9 Adverse events ‐ hypoproteinaemia.

Summary of findings for the main comparison. Interventions compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Any intervention compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: any intervention
Comparison: placebo or no prophylaxis

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo or no prophylaxis

Risk with Interventions

Clinically important upper GI bleeding

Follow‐up: 15 days

Study population

RR 0.47
(0.39 to 0.57)

3207
(30 RCTs)

⊕⊕⊕⊝
MODERATEa

188 per 1000

88 per 1000
(73 to 107)

Nosocomial pneumonia

Follow‐up: 48 hours after extubation

Study population

RR 1.15
(0.90 to 1.48)

1331
(9 RCTs)

⊕⊕⊝⊝
LOWb,c

143 per 1000

164 per 1000
(129 to 211)

All‐cause mortality in ICU

Follow‐up: 4 weeks§

Study population

RR 1.10
(0.90 to 1.34)

2159
(19 RCTs)

⊕⊕⊝⊝
LOWb,d

152 per 1000

168 per 1000
(137 to 204)

Duration of ICU stay

Follow‐up: not reported

Mean duration of ICU stay ranged from 8.6 to 11.1 days

MD 0.24 days higher
(1.13 days lower to 1.61 higher days)

447
(2 RCTs)

⊕⊕⊝⊝
LOWb,e

Number of participants requiring blood transfusion

Follow‐up: 48 hours after discharge

Study population

RR 0.63
(0.41 to 0.97)

981
(9 RCTs)

⊕⊕⊕⊝
MODERATEf

96 per 1000

60 per 1000
(39 to 93)

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Duration of follow‐up reported in one study.

Duration of follow‐up reported in four studies.

§Duration of follow‐up reported in five studies.
CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in nine studies, high risk of detection bias in five studies, high risk of attrition bias in four studies, high risk of reporting bias in five studies, and high risk of other biases in four studies.

bDowngraded by one level for imprecision because effect estimate and 95% CI were compatible with benefit and harm.

cDowngraded by one level for risk of bias because of high risk of performance bias in three studies, high risk of detection bias in one study, and high risk of attrition bias in two studies.

dDowngraded by one level for risk of bias because of high risk of performance bias in seven studies and high risk of attrition bias in two studies.

eDowngraded by one level for risk of bias because of high risk of performance bias in one study.

fDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in two studies, high risk of attrition bias in one study, high risk of reporting bias in one study, and high risk of other biases in one study.

Figuras y tablas -
Summary of findings for the main comparison. Interventions compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Summary of findings 2. H2 receptor antagonists compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

H2 receptor antagonists compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: H2 receptor antagonists
Comparison: placebo or no prophylaxis

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo or no prophylaxis

Risk with H2 receptor antagonists

Clinically important upper GI bleeding

Follow‐up: 15 days/weeks

Study population

RR 0.50
(0.36 to 0.70)

2149
(24 RCTs)

⊕⊕⊕⊝
MODERATEa

182 per 1000

91 per 1000
(65 to 127)

Nosocomial pneumonia

Follow‐up: 48 hours after extubation

Study population

RR 1.12
(0.85 to 1.48)

945
(8 RCTs)

⊕⊕⊝⊝
LOWb,c

146 per 1000

164 per 1000
(124 to 216)

All‐cause mortality in ICU

Follow‐up: 4 weeks§

Study population

RR 1.12
(0.88 to 1.42)

1428
(14 RCTs)

⊕⊕⊝⊝
LOWb,d

145 per 1000

162 per 1000
(127 to 205)

Duration of ICU stay

Follow‐up: not reported

Mean duration of ICU stay ranged from 8.6 to 11.1 days

MD 0.73 days higher
(0.92 days lower to 2.38 days higher)

230
(2 RCTs)

⊕⊕⊝⊝
LOWb,e

Number of participants requiring blood transfusions

Follow‐up: 48 hours after extubationǁ

Study population

RR 0.58
(0.36 to 0.95)

655
(7 RCTs)

⊕⊕⊕⊝
MODERATEf

112 per 1000

65 per 1000
(40 to 107)

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Duration of follow‐up reported in four studies.

Duration of follow‐up reported in two studies.

§Duration of follow‐up reported in five studies.

ǁDuration of follow‐up reported in one study.
CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in eight studies, high risk of attrition bias in two studies, high risk of reporting bias in four studies, and high risk of other biases in three studies.

bDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.

cDowngraded by one level for risk of bias because of high risk performance bias in three studies and high risk of attrition bias in one study.

dDowngraded by one level for risk of bias because of high risk of performance bias in three studies and high risk of attrition bias in one study.

eDowngraded by one level for risk of bias because of high risk of performance bias in one study.

fDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in two studies, high risk of attrition bias in one study, and high risk of other biases in one study.

Figuras y tablas -
Summary of findings 2. H2 receptor antagonists compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Summary of findings 3. Proton pump inhibitors compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Proton pump inhibitors compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: proton pump inhibitors
Comparison: placebo or no prophylaxis

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo or no prophylaxis

Risk with proton pump inhibitors

Clinically important upper GI bleeding

Follow‐up: not reported

Study population

RR 0.63
(0.18 to 2.22)

237
(3 RCTs)

⊕⊕⊝⊝
LOWa,b

49 per 1000

31 per 1000
(9 to 108)

Nosocomial pneumonia

Follow‐up: not reported

Study population

RR 1.24
(0.77 to 1.98)

227
(2 RCTs)

⊕⊕⊝⊝
LOWa,c

188 per 1000

233 per 1000
(145 to 372)

All‐cause mortality in ICU

Follow‐up: not reported

Study population

RR 1.09
(0.60 to 1.99)

258
(3 RCTs)

⊕⊕⊝⊝
LOWa,c

134 per 1000

146 per 1000
(80 to 266)

Duration of ICU stay

Follow‐up: not reported

Mean duration of ICU stay ranged from 8.6 to 11.1 days

MD 0.03 days lower
(1.63 days lower to 1.58 days higher)

227
(2 RCTs)

⊕⊕⊝⊝
LOWa,c

Number of participants requiring blood transfusion

Not reported

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.

bDowngraded by one level for risk of bias because of high risk of performance bias in one study and high risk of attrition bias in one study.

cDowngraded by one level for risk of bias because of high risk of performance bias in one study.

Figuras y tablas -
Summary of findings 3. Proton pump inhibitors compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Summary of findings 4. Antacids compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Antacids compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: antacids
Comparison: placebo or no prophylaxis

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo or no prophylaxis

Risk with antacids

Clinically important upper GI bleeding

Follow‐up: not reported

Study population

RR 0.49
(0.25 to 0.99)

774
(8 RCTs)

⊕⊕⊝⊝
LOWa,b

170 per 1000

83 per 1000
(43 to 168)

Nosocomial pneumonia

Not reported

All‐cause mortality in ICU

Follow‐up: not reported

Study population

RR 1.01
(0.53 to 1.96)

300
(2 RCTs)

⊕⊕⊝⊝
LOWc,d

161 per 1000

163 per 1000
(85 to 316)

Duration of ICU stay

Not reported

Number of participants requiring blood transfusions

Follow‐up: not reported

Study population

RR 0.94
(0.30 to 2.96)

226
(2 RCTs)

⊕⊕⊝⊝
LOWc,e

45 per 1000

43 per 1000
(14 to 135)

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for inconsistency because of moderate heterogeneity; I² = 56%.

bDowngraded by one level for risk of bias because of high risk of performance bias in five studies, high risk of detection bias in one study, high risk of reporting bias in two studies, and high risk of other biases in one study.

cDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.

dDowngraded by one level for risk of bias because of high risk of performance bias in two studies.

eDowngraded by one level for risk of bias because of high risk of performance bias in one study.

Figuras y tablas -
Summary of findings 4. Antacids compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Summary of findings 5. Sucralfate compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Sucralfate compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: sucralfate
Comparison: placebo or no prophylaxis

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo or no prophylaxis

Risk with sucralfate

Clinically important upper GI bleeding

Follow‐up: 15 days

Study population

RR 0.53
(0.32 to 0.88)

598
(7 RCTs)

⊕⊕⊕⊝
MODERATEa

108 per 1000

57 per 1000
(35 to 95)

Nosocomial pneumonia

Follow‐up: not reported

Study population

RR 1.33
(0.86 to 2.04)

450
(4 RCTs)

⊕⊕⊝⊝
LOWb,c

122 per 1000

163 per 1000
(105 to 249)

All‐cause mortality in ICU

Follow‐up: 15 days

Study population

RR 0.97
(0.66 to 1.43)

500
(5 RCTs)

⊕⊕⊝⊝
LOWb,d

165 per 1000

160 per 1000
(109 to 236)

Duration of ICU stay

Follow‐up: not reported

Mean duration of ICU stay ranged from 8.6 to 11.1 days

MD 0.02 days lower
(1.70 days lower to 1.65 days higher)

224
(2 RCTs)

⊕⊕⊝⊝
LOWb,e

Number of participants requiring blood transfusion

Follow‐up: not reported

Study population

RR 0.60
(0.15 to 2.44)

200
(1 RCT)

⊕⊕⊝⊝
LOWb,e

50 per 1000

30 per 1000
(8 to 122)

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Duration of follow‐up reported in only one study.
CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for risk of bias because of high risk of performance bias in five studies, high risk of reporting bias in one study, and high risk of other biases in one study.

bDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.

cDowngraded by one level for risk of bias because of high risk of performance bias in two studies.

dDowngraded by one level for risk of bias because of high risk of performance bias in three studies.

eDowngraded by one level for risk of bias because of high risk of performance bias in one study.

Figuras y tablas -
Summary of findings 5. Sucralfate compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Summary of findings 6. H2 receptor antagonists compared with proton pump inhibitors for preventing upper gastrointestinal bleeding in people admitted to intensive care units

H2 receptor antagonists compared with proton pump inhibitors for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: H2 receptor antagonists
Comparison: proton pump inhibitors

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with proton pump inhibitors

Risk with H2 receptor antagonists

Clinically important upper GI bleeding

Follow‐up: not reported

Study population

RR 2.90
(1.83 to 4.58)

1636
(13 RCTs)

⊕⊕⊝⊝
LOWa,b

25 per 1000

73 per 1000
(46 to 115)

Nosocomial pneumonia

Follow‐up: 30 days

Study population

RR 1.02
(0.77 to 1.35)

1256
(10 RCTs)

⊕⊕⊝⊝
LOWc,d

123 per 1000

126 per 1000
(95 to 166)

All‐cause mortality in ICU

Follow‐up: 30 days

Study population

RR 0.96
(0.78 to 1.19)

1564
(12 RCTs)

⊕⊕⊝⊝
LOWc,e

158 per 1000

152 per 1000
(124 to 189)

Duration of ICU stay

Follow‐up: not reported

Mean duration of ICU stay ranged from 7.7 to 23.6 days

MD 0.14 days higher
(1.14 days lower to 1.41 days higher)

482
(5 RCTs)

⊕⊕⊝⊝
LOWc,f

Number of participants requiring blood transfusion

Follow‐up: not reported

Study population

RR 1.98
(0.75 to 5.21)

575
(3 RCTs)

⊕⊕⊕⊝
MODERATEc

17 per 1000

35 per 1000
(13 to 91)

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Duration of follow‐up reported in only one study.
CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for inconsistency because of substantial heterogeneity; I² = 59%.

bDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in five studies, high risk of detection bias in two studies, and high risk of other biases in one study.

cDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.

dDowngraded by one level for risk of bias because of high risk of performance bias in four studies, high risk of detection bias in two studies, and high risk of other biases in one study.

eDowngraded by one level for risk of bias because of high risk of performance bias in five studies, high risk of attrition bias in one study, and high risk of other biases in one study.

fDowngraded by one level for risk of bias because of high risk of performance bias in three studies, high risk of attrition bias in one study, and high risk of other biases in one study.

Figuras y tablas -
Summary of findings 6. H2 receptor antagonists compared with proton pump inhibitors for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Summary of findings 7. H2 receptor antagonists compared with antacids for preventing upper gastrointestinal bleeding in people admitted to intensive care units

H2 receptor antagonists compared with antacids for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: H2 receptor antagonists
Comparison: antacids

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with antacids

Risk with H2 receptor antagonists

Clinically important upper GI bleeding

Follow‐up: 25 days

Study population

RR 0.96
(0.67 to 1.36)

1700
(16 RCTs)

⊕⊕⊝⊝
LOWa,b

86 per 1000

82 per 1000
(57 to 117)

Nosocomial pneumonia

Follow‐up: 25 days

Study population

RR 1.05
(0.81 to 1.36)

581
(4 RCTs)

⊕⊕⊝⊝
LOWa,c

280 per 1000

294 per 1000
(227 to 381)

All‐cause mortality in ICU

Follow‐up: 25 days§

Study population

RR 1.01
(0.66 to 1.55)

1321
(11 RCTs)

⊕⊝⊝⊝
VERY LOWa,d,e

163 per 1000

165 per 1000
(108 to 253)

Duration of ICU stay

Not reported

Number of participants requiring blood transfusion

Follow‐up: not reported

Study population

RR 2.49
(1.35 to 4.62)

744
(6 RCTs)

⊕⊕⊕⊝
MODERATEf

30 per 1000

75 per 1000
(41 to 139)

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Duration of follow‐up reported in two studies.

Duration of follow‐up reported in one study.

§Duration of follow‐up reported in three studies.
CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.

bDowngraded by one level for risk of bias because of high risk of selection bias in two studies, high risk of performance bias in 12 studies, high risk of detection bias in two studies, and high risk of reporting bias in two studies.

cDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in four studies, high risk of detection bias in one study, and high risk of reporting bias in one study.

dDowngraded by one level for inconsistency because of moderate heterogeneity; I² = 53%.

eDowngraded by one level for risk of bias because of high risk of selection bias in two studies, high risk of performance bias in nine studies, and high risk of reporting bias in one study.

fDowngraded by one level for risk of bias because of high risk of selection bias in one study and high risk of performance bias in four studies.

Figuras y tablas -
Summary of findings 7. H2 receptor antagonists compared with antacids for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Summary of findings 8. H2 receptor antagonists compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units

H2 receptor antagonists compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: H2 receptor antagonists
Comparison: sucralfate

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with sucralfate

Risk with H2 receptor antagonists

Clinically important upper GI bleeding

Follow‐up: 15 days

Study population

RR 1.10
(0.87 to 1.41)

3316
(24 RCTs)

⊕⊕⊝⊝
LOWa,b

66 per 1000

73 per 1000
(58 to 93)

Nosocomial pneumonia

Follow‐up: 25 days

Study population

RR 1.22
(1.07 to 1.40)

3041
(17 RCTs)

⊕⊕⊕⊝
MODERATEc

189 per 1000

230 per 1000
(202 to 264)

All‐cause mortality in ICU

Follow‐up: 25 days§

Study population

RR 1.09
(0.95 to 1.24)

3178
(21 RCTs)

⊕⊕⊝⊝
LOWa,d

204 per 1000

222 per 1000
(194 to 253)

Duration of ICU stay

Follow‐up: 2 weeks

Mean duration of ICU stay ranged from 7.9 to 13.7 days

MD 0.01 days higher
(1.92 days lower to 1.95 days higher)

1791
(6 RCTs)

⊕⊝⊝⊝
VERY LOWa,e,f

Number of participants requiring blood transfusion

Follow‐up: until death or dischargeǁ

Study population

RR 1.25
(0.70 to 2.23)

1095
(9 RCTs)

⊕⊕⊝⊝
LOWa,g

35 per 1000

43 per 1000
(24 to 77)

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

Duration of follow‐up reported in five studies.

Duration of follow‐up reported in three studies.

§Duration of follow‐up reported in six studies.

ǁDuration of follow‐up reported in one study.
CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.

bDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in 20 studies, high risk of detection bias in two studies, high risk of attrition bias in two studies, high risk of reporting bias in four studies, and high risk of other biases in two studies.

cDowngraded by one level for risk of bias because of high risk of selection bias in two studies, high risk of performance bias in 12 studies, high risk of detection bias in one study, high risk of attrition bias in one study, and high risk of reporting bias in two studies.

dDowngraded by one level for risk of bias because of high risk of selection bias in two studies, high risk of performance bias in 16 studies, high risk of detection bias in one study, high risk of attrition bias in two studies, high risk of reporting bias in three studies, and high risk of other biases in one study.

eDowngraded by one level for inconsistency because of considerable heterogeneity; I² = 82%.

fDowngraded by one level for risk of bias because of high risk of performance bias in four studies and high risk of attrition bias in one study.

gDowngraded by one level for risk of bias because of high risk of performance bias in eight studies, high risk of attrition bias in one study, high risk of reporting bias in one study, and high risk of other biases in one study.

Figuras y tablas -
Summary of findings 8. H2 receptor antagonists compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Summary of findings 9. Antacids compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Antacids compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units

Patient or population: people admitted to intensive care units
Setting: ICU
Intervention: antacids
Comparison: sucralfate

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with sucralfate

Risk with antacids

Clinically important upper GI bleeding

Follow‐up: 21 days

Study population

RR 1.00
(0.72 to 1.39)

1772
(16 RCTs)

⊕⊕⊝⊝
LOWa,b

66 per 1000

66 per 1000
(47 to 91)

Nosocomial pneumonia

Follow‐up: 25 days

Study population

RR 1.04
(0.84 to 1.30)

996
(7 RCTs)

⊕⊕⊝⊝
LOWa,c

232 per 1000

242 per 1000
(195 to 302)

All‐cause mortality in ICU

Follow‐up: 25 days

Study population

RR 1.15
(0.93 to 1.40)

1249
(11 RCTs)

⊕⊕⊝⊝
LOWa,d

206 per 1000

237 per 1000
(192 to 289)

Duration of ICU stay

Follow‐up: not reported

Mean duration of ICU stay ranged from 10.4 to 16.8 days

MD 2.5 days lower
(6.61 days lower to 1.61 days higher)

227
(2 RCTs)

⊕⊕⊝⊝
LOWa,e

Number of participants requiring blood transfusion

Follow‐up: until discharge or onset of GI bleeding§

Study population

RR 0.73
(0.40 to 1.34)

667
(6 RCTs)

⊕⊕⊝⊝
LOWa,f

52 per 1000

38 per 1000
(21 to 69)

Serious adverse events

Not reported

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Duration of follow‐up reported in four studies.

Duration of follow‐up reported in two studies.

§Duration of follow‐up reported in one study.
CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.

bDowngraded by one level for risk of bias because of high risk of selection bias in three studies, high risk of performance bias in 12 studies, high risk of detection bias in one study, high risk of attrition bias in one study, high risk of reporting bias in two studies, and high risk of other biases in two studies.

cDowngraded by one level for risk of bias because of high risk of performance bias in four studies, high risk of detection bias in one study, high risk of reporting bias in one study, and high risk of other biases in one study.

dDowngraded by one level for risk of bias because of high risk of selection bias in three studies, high risk of performance bias in eight studies, high risk of attrition bias in one study, high risk of reporting bias in one study, and high risk of other biases in one study.

eDowngraded by one level for risk of bias because of high risk of attrition bias in one study.

fDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in six studies, and high risk of other biases in one study.

Figuras y tablas -
Summary of findings 9. Antacids compared with sucralfate for preventing upper gastrointestinal bleeding in people admitted to intensive care units
Comparison 1. Interventions versus placebo or no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

30

3132

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.39, 0.57]

1.1 H2 receptor antagonists vs placebo or no prophylaxis

24

1844

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.37, 0.59]

1.2 Proton pump inhibitors vs placebo or no prophylaxis

3

159

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.13, 2.59]

1.3 Prostagladin analogues vs placebo or no prophylaxis

1

58

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.22, 4.55]

1.4 Anticholinergics vs placebo or no prophylaxis

2

103

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.30, 2.49]

1.5 Antacids vs placebo or no prophylaxis

7

515

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.23, 0.63]

1.6 Sucralfate vs placebo or no prophylaxis

7

453

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.25, 0.87]

2 Nosocomial pneumonia Show forest plot

9

1331

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.90, 1.48]

2.1 H2 receptor antagonists vs placebo or no prophylaxis

8

788

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.77, 1.46]

2.2 Proton pump inhibitors vs placebo or no prophylaxis

2

149

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.59, 2.17]

2.3 Anticholinergics vs placebo or no prophylaxis

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.43, 2.59]

2.4 Sucralfate vs placebo or no prophylaxis

4

322

Risk Ratio (M‐H, Fixed, 95% CI)

1.59 [0.84, 3.01]

3 All‐cause mortality in ICU Show forest plot

19

2159

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.90, 1.34]

3.1 H2 receptor antagonists vs placebo or no prophylaxis

14

1209

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.89, 1.53]

3.2 Proton pump inhibitors vs placebo or no prophylaxis

3

180

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.46, 2.38]

3.3 Prostagladin analogues vs placebo or no prophylaxis

1

58

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.48, 2.74]

3.4 Anticholinergics vs placebo or no prophylaxis

2

103

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.59, 2.56]

3.5 Antacids vs placebo or no prophylaxis

2

250

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.58, 1.79]

3.6 Sucralfate vs placebo or no prophylaxis

5

359

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.58, 1.51]

4 All‐cause mortality in hospital Show forest plot

5

857

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.85, 1.55]

4.1 H2 receptor antagonists vs placebo or no prophylaxis

4

387

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.71, 1.83]

4.2 Proton pump inhibitors vs placebo or no prophylaxis

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.42, 3.22]

4.3 Antacids vs placebo or no prophylaxis

1

126

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.79, 2.64]

4.4 Sucralfate vs placebo or no prophylaxis

2

244

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.53, 1.68]

5 Duration of ICU stay Show forest plot

2

447

Mean Difference (IV, Fixed, 95% CI)

0.24 [‐1.13, 1.61]

5.1 H2 receptor antagonists vs placebo or no prophylaxis

2

152

Mean Difference (IV, Fixed, 95% CI)

0.73 [‐1.64, 3.09]

5.2 Proton pump inhibitors vs placebo or no prophylaxis

2

149

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐2.33, 2.35]

5.3 Sucralfate vs placebo or no prophylaxis

2

146

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐2.40, 2.38]

6 Duration of intubation Show forest plot

2

447

Mean Difference (IV, Fixed, 95% CI)

0.87 [‐0.58, 2.31]

6.1 H2 receptor antagonists vs placebo or no prophylaxis

2

152

Mean Difference (IV, Fixed, 95% CI)

0.78 [‐1.72, 3.29]

6.2 Proton pump inhibitors vs placebo or no prophylaxis

2

149

Mean Difference (IV, Fixed, 95% CI)

0.36 [‐2.18, 2.90]

6.3 Sucralfate vs placebo or no prophylaxis

2

146

Mean Difference (IV, Fixed, 95% CI)

1.43 [‐1.04, 3.89]

7 Number of participants requiring blood transfusions Show forest plot

9

981

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.41, 0.97]

7.1 H2 receptor antagonists vs placebo or no prophylaxis

7

605

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.35, 0.94]

7.2 Antacids vs placebo or no prophylaxis

2

226

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.30, 2.96]

7.3 Sucralfate vs placebo or no prophylaxis

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.13, 4.34]

8 Units of blood transfused Show forest plot

2

309

Mean Difference (IV, Random, 95% CI)

0.09 [‐0.99, 1.17]

8.1 H2 receptor antagonists vs placebo or no prophylaxis

2

159

Mean Difference (IV, Random, 95% CI)

‐1.73 [‐6.37, 2.90]

8.2 Sucralfate vs placebo or no prophylaxis

1

150

Mean Difference (IV, Random, 95% CI)

0.80 [0.25, 1.35]

Figuras y tablas -
Comparison 1. Interventions versus placebo or no prophylaxis
Comparison 2. H2 receptor antagonists versus placebo or no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

24

2149

Risk Ratio (M‐H, Random, 95% CI)

0.50 [0.36, 0.70]

1.1 Cimetidine vs placebo

10

772

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.28, 1.02]

1.2 Famotidine vs placebo

1

146

Risk Ratio (M‐H, Random, 95% CI)

2.11 [0.20, 22.79]

1.3 Ranitidine vs placebo

5

446

Risk Ratio (M‐H, Random, 95% CI)

0.36 [0.17, 0.77]

1.4 Cimetidine vs no prophylaxis

3

516

Risk Ratio (M‐H, Random, 95% CI)

0.59 [0.23, 1.48]

1.5 Famotidine vs no prophylaxis

1

50

Risk Ratio (M‐H, Random, 95% CI)

0.3 [0.09, 0.96]

1.6 Ranitidine vs no prophylaxis

4

219

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.26, 1.00]

2 Nosocomial pneumonia Show forest plot

8

945

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.85, 1.48]

2.1 Cimetidine vs placebo

2

204

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.06, 2.00]

2.2 Famotidine vs placebo

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [0.49, 4.45]

2.3 Ranitidine vs placebo

2

277

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.47, 1.31]

2.4 Cimetidine vs no prophylaxis

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

2.17 [0.86, 5.47]

2.5 Ranitidine vs no prophylaxis

2

118

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.93, 1.90]

3 All‐cause mortality in ICU Show forest plot

14

1428

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.88, 1.42]

3.1 Cimetidine vs placebo

4

478

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.66, 1.68]

3.2 Famotidine vs placebo

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.55, 3.16]

3.3 Ranitidine vs placebo

2

148

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.31, 1.54]

3.4 Cimetidine vs no prophylaxis

2

400

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.61, 1.63]

3.5 Famotidine vs no prophylaxis

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.59, 2.64]

3.6 Ranitidine vs no prophylaxis

4

206

Risk Ratio (M‐H, Fixed, 95% CI)

1.58 [0.97, 2.58]

4 All‐cause mortality in hospital Show forest plot

4

487

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.79, 1.70]

4.1 Famotidine vs placebo

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.43, 1.86]

4.2 Ranitidine vs placebo

1

101

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.47]

4.3 Cimetidine vs no prophylaxis

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

1.47 [0.88, 2.46]

4.4 Ranitidine vs no prophylaxis

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.33, 2.53]

5 Duration of ICU stay Show forest plot

2

230

Mean Difference (IV, Fixed, 95% CI)

0.73 [‐0.92, 2.38]

5.1 Famotidine vs placebo

1

146

Mean Difference (IV, Fixed, 95% CI)

1.5 [‐1.93, 4.93]

5.2 Ranitidine vs no prophylaxis

1

84

Mean Difference (IV, Fixed, 95% CI)

0.5 [‐1.38, 2.38]

6 Duration of intubation Show forest plot

2

230

Mean Difference (IV, Fixed, 95% CI)

0.79 [‐0.95, 2.54]

6.1 Famotidine vs placebo

1

146

Mean Difference (IV, Fixed, 95% CI)

1.20 [‐1.86, 4.26]

6.2 Ranitidine vs no prophylaxis

1

84

Mean Difference (IV, Fixed, 95% CI)

0.60 [‐1.52, 2.72]

7 Number of participants requiring blood transfusions Show forest plot

7

655

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.36, 0.95]

7.1 Cimetidine vs placebo

3

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.19, 0.79]

7.2 Ranitidine vs placebo

2

148

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.24, 4.60]

7.3 Cimetidine vs no prophylaxis

2

400

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.35, 1.71]

8 Units of blood transfused Show forest plot

2

209

Mean Difference (IV, Fixed, 95% CI)

0.33 [‐0.04, 0.70]

8.1 Cimetidine vs placebo

1

9

Mean Difference (IV, Fixed, 95% CI)

‐4.35 [‐7.35, ‐1.35]

8.2 Cimetidine vs no prophylaxis

1

200

Mean Difference (IV, Fixed, 95% CI)

0.40 [0.03, 0.77]

9 Adverse events of interventions Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Diarrhoea

2

225

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.57, 2.96]

9.2 Thrombocytopenia

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.12, 72.77]

9.3 Hypophosphatemia

1

25

Risk Ratio (M‐H, Fixed, 95% CI)

3.75 [0.17, 84.02]

9.4 Mental confusion

5

657

Risk Ratio (M‐H, Fixed, 95% CI)

2.01 [1.10, 3.65]

9.5 Nausea and vomiting

2

287

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.09, 2.35]

9.6 Increased creatinine levels

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.64, 1.69]

9.7 Erythema

1

70

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 71.22]

9.8 Pancreatitis

1

39

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 6.66]

9.9 Chest infection

1

101

Risk Ratio (M‐H, Fixed, 95% CI)

1.74 [0.92, 3.30]

9.10 Delirium

1

39

Risk Ratio (M‐H, Fixed, 95% CI)

2.59 [0.11, 59.93]

9.11 Hallucinations

1

39

Risk Ratio (M‐H, Fixed, 95% CI)

2.59 [0.11, 59.93]

9.12 Severe bleeding

1

101

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.47]

Figuras y tablas -
Comparison 2. H2 receptor antagonists versus placebo or no prophylaxis
Comparison 3. Proton pump inhibitors versus placebo or no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

3

237

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.18, 2.22]

1.1 Omeprazole vs placebo

1

147

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.07, 16.34]

1.2 Omeprazole vs no prophylaxis

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.13, 4.18]

1.3 Pantoprazole vs placebo

1

10

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.02, 4.66]

2 Nosocomial pneumonia Show forest plot

2

227

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.77, 1.98]

2.1 Omeprazole vs placebo

1

147

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [0.57, 4.86]

2.2 Omeprazole vs no prophylaxis

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.66, 1.84]

3 All‐cause mortality in ICU Show forest plot

3

258

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.60, 1.99]

3.1 Omeprazole vs placebo

2

178

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.51, 2.83]

3.2 Omeprazole vs no prophylaxis

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.42, 2.29]

4 All‐cause mortality in hospital Show forest plot

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.54, 2.13]

4.1 Omeprazole vs placebo

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.54, 2.13]

5 Duration of ICU stay Show forest plot

2

227

Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐1.63, 1.58]

5.1 Omeprazole vs placebo

1

147

Mean Difference (IV, Fixed, 95% CI)

‐0.90 [‐3.96, 2.16]

5.2 Omeprazole vs no prophylaxis

1

80

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐1.58, 2.18]

6 Duration of intubation Show forest plot

2

227

Mean Difference (IV, Fixed, 95% CI)

0.36 [‐1.43, 2.15]

6.1 Omeprazole vs placebo

1

147

Mean Difference (IV, Fixed, 95% CI)

0.5 [‐2.72, 3.72]

6.2 Omeprazole vs no prophylaxis

1

80

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐1.85, 2.45]

Figuras y tablas -
Comparison 3. Proton pump inhibitors versus placebo or no prophylaxis
Comparison 4. Proton pump inhibitors + sucralfate versus no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 4. Proton pump inhibitors + sucralfate versus no prophylaxis
Comparison 5. Prostaglandin analogues versus placebo or no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Prostaglandin analogues vs placebo

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 All‐cause mortality in ICU Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 5. Prostaglandin analogues versus placebo or no prophylaxis
Comparison 6. Anticholinergics versus placebo or no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

2

131

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.36, 2.51]

1.1 Pirenzepine vs placebo

1

101

Risk Ratio (M‐H, Fixed, 95% CI)

1.94 [0.34, 11.13]

1.2 Pirenzepin + ranitidine vs placebo + ranitidine

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.17, 2.07]

2 Nosocomial pneumonia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Pirenzepine vs placebo

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 All‐cause mortality in ICU Show forest plot

2

131

Risk Ratio (M‐H, Fixed, 95% CI)

1.23 [0.66, 2.30]

3.1 Pirenzepine vs placebo

1

101

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.65, 2.60]

3.2 Pirenzepine + ranitidine vs placebo + ranitidine

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.24, 4.18]

Figuras y tablas -
Comparison 6. Anticholinergics versus placebo or no prophylaxis
Comparison 7. Antacids versus placebo or no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

8

774

Risk Ratio (M‐H, Random, 95% CI)

0.49 [0.25, 0.99]

1.1 Antacids vs placebo

2

145

Risk Ratio (M‐H, Random, 95% CI)

2.04 [0.72, 5.79]

1.2 Antacids vs no prophylaxis

6

629

Risk Ratio (M‐H, Random, 95% CI)

0.35 [0.20, 0.60]

2 All‐cause mortality in ICU Show forest plot

2

300

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.53, 1.96]

2.1 Antacids vs no prophylaxis

2

300

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.53, 1.96]

3 All‐cause mortality in hospital Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Antacids vs no prophylaxis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of participants requiring blood transfusions Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Antacids vs no prophylaxis

2

226

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.30, 2.96]

5 Adverse events of interventions Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Diarrhoea

4

395

Risk Ratio (M‐H, Fixed, 95% CI)

3.56 [1.83, 6.94]

5.2 Hypomagnesaemia

1

25

Risk Ratio (M‐H, Fixed, 95% CI)

3.75 [0.17, 84.02]

5.3 Hypophosphataemia

2

225

Risk Ratio (M‐H, Fixed, 95% CI)

5.48 [1.81, 16.61]

5.4 Hypermagnesaemia

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

6.73 [0.36, 127.02]

5.5 Nausea and vomiting

3

370

Risk Ratio (M‐H, Fixed, 95% CI)

2.39 [0.86, 6.64]

5.6 Mental confusion

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

1.27 [0.61, 2.67]

5.7 Creatinine increase

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.73, 1.87]

Figuras y tablas -
Comparison 7. Antacids versus placebo or no prophylaxis
Comparison 8. Sucralfate versus placebo or no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

7

598

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.32, 0.88]

1.1 Sucralfate vs placebo

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.30, 6.62]

1.2 Sucralfate vs no prophylaxis

5

428

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.26, 0.80]

2 Nosocomial pneumonia Show forest plot

4

450

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.86, 2.04]

2.1 Sucralfate vs placebo

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.43 [0.49, 4.16]

2.2 Sucralfate vs no prophylaxis

2

280

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.82, 2.07]

3 All‐cause mortality in ICU Show forest plot

5

500

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.66, 1.43]

3.1 Sucralfate vs placebo

2

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.48, 1.80]

3.2 Sucralfate vs no prophylaxis

3

330

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.62, 1.60]

4 All‐cause mortality in hospital Show forest plot

2

344

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.62, 1.52]

4.1 Sucralfate vs placebo

1

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.54, 2.18]

4.2 Sucralfate vs no prophylaxis

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.49, 1.62]

5 Duration of ICU stay Show forest plot

2

224

Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐1.70, 1.65]

5.1 Sucralfate vs placebo

1

144

Mean Difference (IV, Fixed, 95% CI)

‐0.70 [‐4.07, 2.67]

5.2 Sucralfate vs no prophylaxis

1

80

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐1.73, 2.13]

6 Duration of intubation Show forest plot

2

224

Mean Difference (IV, Fixed, 95% CI)

1.42 [‐0.27, 3.10]

6.1 Sucralfate vs placebo

1

144

Mean Difference (IV, Fixed, 95% CI)

0.80 [‐2.20, 3.80]

6.2 Sucralfate vs no prophylaxis

1

80

Mean Difference (IV, Fixed, 95% CI)

1.70 [‐0.34, 3.74]

7 Number of participants requiring blood transfusions Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 Sucralfate vs no prophylaxis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Units of blood transfused Show forest plot

1

200

Mean Difference (IV, Fixed, 95% CI)

0.8 [0.32, 1.28]

8.1 Sucralfate vs no prophylaxis

1

200

Mean Difference (IV, Fixed, 95% CI)

0.8 [0.32, 1.28]

9 Adverse events of interventions Show forest plot

1

70

Risk Ratio (M‐H, Fixed, 95% CI)

9.0 [0.50, 161.13]

9.1 Nausea / Vomiting

1

70

Risk Ratio (M‐H, Fixed, 95% CI)

9.0 [0.50, 161.13]

Figuras y tablas -
Comparison 8. Sucralfate versus placebo or no prophylaxis
Comparison 9. H2 receptor antagonists versus proton pump inhibitors

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

13

1636

Risk Ratio (M‐H, Fixed, 95% CI)

2.90 [1.83, 4.58]

1.1 Cimetidine vs omeprazole

1

359

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.55, 3.61]

1.2 Famotidine vs lansoprazole

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

3.63 [0.15, 84.98]

1.3 Famotidine vs omeprazole

1

143

Risk Ratio (M‐H, Fixed, 95% CI)

2.03 [0.19, 21.87]

1.4 Famotidine vs pantoprazole

2

159

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.18, 3.04]

1.5 Famotidine vs esomeprazole

2

371

Risk Ratio (M‐H, Fixed, 95% CI)

7.53 [1.39, 40.85]

1.6 Ranitidine vs omeprazole

5

413

Risk Ratio (M‐H, Fixed, 95% CI)

4.08 [1.99, 8.36]

1.7 Ranitidine vs rabeprazole

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

9.0 [0.49, 164.09]

2 Nosocomial pneumonia Show forest plot

10

1256

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.77, 1.35]

2.1 Cimetidine vs omeprazole

1

359

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.45, 1.54]

2.2 Cimetidine vs pantoprazole

1

202

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.28, 2.91]

2.3 Famotidine vs esomeprazole

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.07, 15.26]

2.4 Famotidine vs omeprazole

1

143

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.34, 2.32]

2.5 Ranitidine vs omeprazole

5

413

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.80, 1.75]

2.6 H2 receptor antagonists (not defined) vs proton pump inhibitors (not defined)

1

79

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.47, 2.26]

3 All‐cause mortality in ICU Show forest plot

12

1564

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.78, 1.19]

3.1 Cimetidine vs omeprazole

1

359

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.45, 1.30]

3.2 Cimetidine vs pantoprazole

1

202

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.25, 2.55]

3.3 Famotidine vs omeprazole

1

143

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.49, 2.61]

3.4 Ranitidine vs omeprazole

5

387

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.86, 1.40]

3.5 Ranitidine vs pantoprazole

3

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.31, 1.43]

3.6 Ranitidine vs rabeprazole

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.12, 72.40]

4 All‐cause mortality in hospital Show forest plot

2

454

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.37, 1.43]

4.1 Famotidine vs esomeprazole

1

311

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.04, 3.49]

4.2 Famotidine vs omeprazole

1

143

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.39, 1.63]

5 Duration of ICU stay Show forest plot

5

482

Mean Difference (IV, Fixed, 95% CI)

0.14 [‐1.14, 1.41]

5.1 Famotidine vs esomeprazole

1

60

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐6.51, 5.91]

5.2 Famotidine vs omeprazole

1

143

Mean Difference (IV, Fixed, 95% CI)

2.40 [‐0.44, 5.24]

5.3 Ranitidine vs omeprazole

3

279

Mean Difference (IV, Fixed, 95% CI)

‐0.44 [‐1.90, 1.02]

6 Duration of intubation Show forest plot

5

542

Mean Difference (IV, Fixed, 95% CI)

‐0.35 [‐1.48, 0.78]

6.1 Famotidine vs omeprazole

1

143

Mean Difference (IV, Fixed, 95% CI)

0.70 [‐2.24, 3.64]

6.2 Ranitidine vs omeprazole

3

279

Mean Difference (IV, Fixed, 95% CI)

‐0.78 [‐2.24, 0.67]

6.3 Ranitidine vs pantoprazole

1

120

Mean Difference (IV, Fixed, 95% CI)

0.07 [‐2.18, 2.32]

7 Number of participants requiring blood transfusions Show forest plot

3

575

Risk Ratio (M‐H, Fixed, 95% CI)

1.98 [0.75, 5.21]

7.1 Cimetidine vs omeprazole

1

359

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.29, 3.34]

7.2 Ranitidine vs omeprazole

1

76

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.25, 100.80]

7.3 Ranitidine vs rabeprazole

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

9.0 [0.49, 164.09]

8 Adverse events of interventions Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Pyrexia

1

202

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.05, 19.03]

8.2 Thrombocytopaenia

2

253

Risk Ratio (M‐H, Fixed, 95% CI)

3.64 [0.65, 20.46]

8.3 Neuroleptic malignant syndrome

1

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [0.06, 37.42]

8.4 Cholestatic jaundice

1

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [0.06, 37.42]

8.5 Abnormal liver function test

1

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [0.06, 37.42]

8.6 Pruritus

1

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [0.06, 37.42]

8.7 Phlebitis

1

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [0.06, 37.42]

8.8 Major CV events

1

311

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.26, 2.43]

8.9 Abdominal distension and vomiting

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.62, 2.14]

8.10 Hypomagnesaemia

1

129

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.16, 1.13]

8.11 Nausea and vomiting

1

129

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.13, 1.77]

8.12 Diarrhoea

1

129

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.16, 7.67]

Figuras y tablas -
Comparison 9. H2 receptor antagonists versus proton pump inhibitors
Comparison 10. H2 receptor antagonists versus antacids

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

16

1700

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.67, 1.36]

1.1 Cimetidine vs antacids

11

1155

Risk Ratio (M‐H, Random, 95% CI)

1.07 [0.65, 1.78]

1.2 Cimetidine + pirenzepine vs antacid + pirenzepine

1

66

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.15, 6.68]

1.3 Ranitidine vs antacids

4

479

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.42, 1.23]

2 Nosocomial pneumonia Show forest plot

4

581

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.81, 1.36]

2.1 Cimetidine vs antacids

2

136

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.70, 2.19]

2.2 Ranitidine vs antacids

2

445

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.75, 1.34]

3 All‐cause mortality in ICU Show forest plot

11

1321

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.66, 1.55]

3.1 Cimetidine vs antacids

8

885

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.69, 1.59]

3.2 Cimetidine + pirenzepine vs antacid + pirenzepine

1

66

Risk Ratio (M‐H, Random, 95% CI)

1.25 [0.37, 4.25]

3.3 Ranitidine vs antacids

2

370

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.14, 8.97]

4 All‐cause mortality in hospital Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Ranitidine vs antacids

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Duration of intubation Show forest plot

3

121

Mean Difference (IV, Random, 95% CI)

‐0.81 [‐3.85, 2.23]

5.1 Cimetidine vs antacids

3

121

Mean Difference (IV, Random, 95% CI)

‐0.81 [‐3.85, 2.23]

6 Number of participants requiring blood transfusions Show forest plot

6

744

Risk Ratio (M‐H, Fixed, 95% CI)

2.49 [1.35, 4.62]

6.1 Cimetidine vs antacids

5

583

Risk Ratio (M‐H, Fixed, 95% CI)

2.47 [1.32, 4.63]

6.2 Ranitidine vs antacids

1

161

Risk Ratio (M‐H, Fixed, 95% CI)

3.04 [0.13, 73.46]

7 Adverse events of interventions Show forest plot

12

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Diarrhoea

6

777

Risk Ratio (M‐H, Fixed, 95% CI)

0.23 [0.13, 0.43]

7.2 Thrombocytopaenia

4

452

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.93, 2.09]

7.3 Nausea and vomiting

4

380

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.19, 1.10]

7.4 Hypophosphataemia

2

108

Risk Ratio (M‐H, Fixed, 95% CI)

0.24 [0.04, 1.30]

7.5 Hypomagnesaemia

1

22

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.02, 7.39]

7.6 Increase in creatinine

2

286

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.56, 1.28]

7.7 Mental confusion

4

476

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [0.77, 2.07]

7.8 Hypermagnesaemia

2

115

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.17, 2.03]

7.9 Rash/Erythema

2

231

Risk Ratio (M‐H, Fixed, 95% CI)

3.02 [0.32, 28.53]

7.10 Alkalosis

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 7.73]

7.11 Dryness of mouth

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

5.15 [0.26, 103.33]

7.12 Leucopaenia

1

161

Risk Ratio (M‐H, Fixed, 95% CI)

3.04 [0.13, 73.46]

Figuras y tablas -
Comparison 10. H2 receptor antagonists versus antacids
Comparison 11. H2 receptor antagonists versus sucralfate

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

24

3316

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.87, 1.41]

1.1 Cimetidine vs sucralfate

7

873

Risk Ratio (M‐H, Fixed, 95% CI)

1.37 [0.87, 2.14]

1.2 Famotidine vs sucralfate

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.21, 1.78]

1.3 Ranitidine vs sucralfate

14

2186

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.76, 1.39]

1.4 Cimetidine + pirenzepine vs sucralfate + pirenzepine

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

5.15 [0.26, 103.33]

2 Nosocomial pneumonia Show forest plot

17

3041

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [1.07, 1.40]

2.1 Cimetidine vs sucralfate

5

758

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.87, 1.47]

2.2 Famotidine vs sucralfate

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.40, 3.20]

2.3 Ranitidine vs sucralfate

11

2143

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [1.07, 1.48]

3 All‐cause mortality in ICU Show forest plot

21

3178

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.95, 1.24]

3.1 Cimetidine vs sucralfate

6

814

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.91, 1.54]

3.2 Famotidine vs sucralfate

2

190

Risk Ratio (M‐H, Fixed, 95% CI)

1.23 [0.69, 2.19]

3.3 Ranitidine vs sucralfate

12

2107

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.88, 1.22]

3.4 Cimetidine + pirenzepine vs sucralfate + pirenzepine

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.38, 4.38]

4 All‐cause mortality in hospital Show forest plot

4

717

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.86, 1.50]

4.1 Cimetidine vs sucralfate

2

413

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.86, 1.92]

4.2 Ranitidine vs sucralfate

1

164

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.71, 1.74]

4.3 Famotidine vs sucralfate

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.40, 1.71]

5 Duration of intubation Show forest plot

10

1751

Mean Difference (IV, Random, 95% CI)

0.22 [‐1.55, 2.00]

5.1 Cimetidine vs sucralfate

2

97

Mean Difference (IV, Random, 95% CI)

0.58 [‐1.71, 2.87]

5.2 Famotidine vs sucralfate

1

140

Mean Difference (IV, Random, 95% CI)

0.40 [‐2.30, 3.10]

5.3 Ranitidine vs sucralfate

7

1514

Mean Difference (IV, Random, 95% CI)

0.15 [‐2.12, 2.43]

6 Duration of ICU stay Show forest plot

6

1791

Mean Difference (IV, Random, 95% CI)

0.01 [‐1.92, 1.95]

6.1 Cimetidine vs sucralfate

1

213

Mean Difference (IV, Random, 95% CI)

0.0 [‐3.05, 3.05]

6.2 Famotidine vs sucralfate

1

140

Mean Difference (IV, Random, 95% CI)

2.20 [‐0.96, 5.36]

6.3 Ranitidine vs sucralfate

4

1438

Mean Difference (IV, Random, 95% CI)

‐0.43 [‐2.70, 1.84]

7 Number of participants requiring blood transfusion Show forest plot

9

1095

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.70, 2.23]

7.1 Cimetidine vs sucralfate

5

732

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.47, 2.16]

7.2 Ranitidine vs sucralfate

4

363

Risk Ratio (M‐H, Fixed, 95% CI)

1.77 [0.71, 4.39]

8 Units of blood transfused Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

8.1 Cimetidine vs sucralfate

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Adverse events of interventions Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Thrombocytopaenia

2

240

Risk Ratio (M‐H, Fixed, 95% CI)

4.72 [0.56, 39.47]

9.2 Nausea and vomiting

2

137

Risk Ratio (M‐H, Fixed, 95% CI)

0.07 [0.01, 0.54]

9.3 Hypermagnesaemia

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

2.71 [0.31, 23.93]

9.4 Rash/Erythema

2

233

Risk Ratio (M‐H, Fixed, 95% CI)

3.06 [0.32, 28.87]

9.5 Confusion

3

382

Risk Ratio (M‐H, Fixed, 95% CI)

4.48 [0.77, 26.00]

9.6 Neutropaenia

1

114

Risk Ratio (M‐H, Fixed, 95% CI)

5.18 [0.25, 105.47]

9.7 Dryness of mouth

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

5.15 [0.26, 103.33]

9.8 Leucopaenia

1

163

Risk Ratio (M‐H, Fixed, 95% CI)

3.11 [0.13, 75.26]

Figuras y tablas -
Comparison 11. H2 receptor antagonists versus sucralfate
Comparison 12. H2 receptor antagonists versus anticholinergics

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

3

556

Risk Ratio (M‐H, Fixed, 95% CI)

1.37 [0.58, 3.26]

1.1 Cimetidine vs pirenzepine

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [0.26, 7.99]

1.2 Ranitidine vs pirenzepine

2

501

Risk Ratio (M‐H, Fixed, 95% CI)

1.35 [0.50, 3.67]

2 Nosocomial pneumonia Show forest plot

3

544

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.50, 1.84]

2.1 Famotidine vs pirenzepine

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 7.42]

2.2 Ranitidine vs pirenzepine

2

501

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.53, 2.01]

3 All‐cause mortality in ICU Show forest plot

2

501

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.21, 3.87]

3.1 Ranitidine vs pirenzepine

2

501

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.21, 3.87]

4 Number of participants requiring blood transfusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Ranitidine vs pirenzepine

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Adverse events of interventions Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Tachycardia

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 1.90]

5.2 High temperature

1

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.21, 1.32]

Figuras y tablas -
Comparison 12. H2 receptor antagonists versus anticholinergics
Comparison 13. H2 receptor antagonists versus prostaglandin analogues

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Cimetidine vs misoprostol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 All‐cause mortality in ICU Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Cimetidine vs misoprostol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 13. H2 receptor antagonists versus prostaglandin analogues
Comparison 14. H2 receptor antagonists versus teprenone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Ranitidine vs teprenone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 All‐cause mortality in ICU Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Ranitidine vs teprenone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of participants requiring blood transfusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Ranitidine vs teprenone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 14. H2 receptor antagonists versus teprenone
Comparison 15. H2 receptor antagonist + antacids versus sucralfate

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

2

230

Risk Ratio (M‐H, Fixed, 95% CI)

0.24 [0.06, 0.95]

1.1 Cimetidine + antacids vs sucralfate

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.01, 2.70]

1.2 Cimetidine or ranitidine + antacids vs sucralfate

1

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.06, 1.41]

2 Nosocomial pneumonia Show forest plot

3

281

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.51, 2.32]

2.1 Cimetidine + antacids vs sucralfate

1

100

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.26, 1.07]

2.2 Ranitidine + antacids vs sucralfate

1

51

Risk Ratio (M‐H, Random, 95% CI)

1.27 [0.64, 2.53]

2.3 Cimetidine or ranitidine + antacids vs sucralfate

1

130

Risk Ratio (M‐H, Random, 95% CI)

2.02 [0.89, 4.58]

3 All‐cause mortality in ICU Show forest plot

2

230

Risk Ratio (M‐H, Fixed, 95% CI)

1.38 [0.92, 2.05]

3.1 Cimetidine + antacids vs sucralfate

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.46, 2.19]

3.2 Cimetidine or ranitidine + antacids vs sucralfate

1

130

Risk Ratio (M‐H, Fixed, 95% CI)

1.57 [0.99, 2.50]

4 Duration of ICU stay Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Duration of intubation Show forest plot

2

230

Mean Difference (IV, Random, 95% CI)

‐1.24 [‐13.82, 11.33]

5.1 Cimetidine + antacids vs sucralfate

1

100

Mean Difference (IV, Random, 95% CI)

‐8.8 [‐20.11, 2.51]

5.2 Cimetidine or ranitidine + antacids vs sucralfate

1

130

Mean Difference (IV, Random, 95% CI)

4.20 [‐0.54, 8.94]

6 Number of participants requiring blood transfusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 15. H2 receptor antagonist + antacids versus sucralfate
Comparison 16. Proton pump inhibitors versus teprenone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Proton pump inhibitors vs teprenone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 All‐cause mortality in ICU Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Proton pump inhibitors vs teprenone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of participants requiring blood transfusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Proton pump inhibitors vs teprenone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 16. Proton pump inhibitors versus teprenone
Comparison 17. Proton pump inhibitor plus naloxone versus naloxone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 All‐cause mortality in hospital Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Adverse events ‐ gastrointestinal discomfort Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 17. Proton pump inhibitor plus naloxone versus naloxone
Comparison 18. Proton pump inhibitors versus other medication (not defined)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Nosocomial pneumonia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 All‐cause mortality in hospital Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 18. Proton pump inhibitors versus other medication (not defined)
Comparison 19. Antacids versus sucralfate

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

16

1772

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.72, 1.39]

1.1 Antacids vs sucralfate

15

1705

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.69, 1.35]

1.2 Antacid + pirenzepine vs sucralfate + pirenzepine

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

5.15 [0.26, 103.33]

2 Nosocomial pneumonia Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Antacids vs sucralfate

7

996

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.84, 1.30]

3 All‐cause mortality in ICU Show forest plot

11

1249

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.93, 1.40]

3.1 Antacid vs sucralfate

10

1182

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.94, 1.41]

3.2 Antacid + pirenzepine vs sucralfate + pirenzepine

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.28, 3.78]

4 All‐cause mortality in hospital Show forest plot

3

450

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.69, 1.39]

5 Duration of ICU stay Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 Antacids vs sucralfate

2

227

Mean Difference (IV, Fixed, 95% CI)

‐2.50 [‐6.61, 1.61]

6 Duration of intubation Show forest plot

4

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 Antacids vs sucralfate

4

281

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.18 [‐0.41, 0.06]

7 Number of participants requiring blood transfusion Show forest plot

6

667

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.40, 1.34]

8 Adverse events of interventions Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Diarrhoea

6

599

Risk Ratio (M‐H, Fixed, 95% CI)

12.40 [3.88, 39.64]

8.2 Hypermagnesaemia

4

317

Risk Ratio (M‐H, Fixed, 95% CI)

4.72 [1.24, 17.95]

8.3 Nausea and vomiting

3

223

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.28, 1.41]

8.4 Thrombocytopaenia

1

38

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.26, 97.70]

8.5 Severe alkalosis

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 71.92]

8.6 Allergic reactions

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.06]

Figuras y tablas -
Comparison 19. Antacids versus sucralfate
Comparison 20. Antacids versus prostaglandin analogues

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

2

329

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.12, 0.91]

2 All‐cause mortality in ICU Show forest plot

2

417

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.42, 1.67]

3 Adverse events of interventions Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Diarrhoea

1

368

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.64, 1.33]

3.2 Elevated serum bicarbonate

1

338

Risk Ratio (M‐H, Fixed, 95% CI)

2.21 [1.27, 3.87]

3.3 Phospate levels < 2.5 mg/dL

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.66 [1.01, 2.73]

Figuras y tablas -
Comparison 20. Antacids versus prostaglandin analogues
Comparison 21. Antacids versus bioflavonoids

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Number of participants requiring blood transfusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 21. Antacids versus bioflavonoids
Comparison 22. Sucralfate versus proton pump inhibitors

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Sucralfate vs omeprazole

3

287

Risk Ratio (M‐H, Fixed, 95% CI)

2.58 [0.77, 8.63]

2 Nosocomial pneumonia Show forest plot

4

424

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.41, 1.09]

2.1 Sucralfate vs omeprazole

3

287

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.57, 1.36]

2.2 Sucralfate vs pantoprazole

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.20, 0.75]

3 All‐cause mortality in ICU Show forest plot

4

424

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.68, 1.68]

3.1 Sucralfate vs omeprazole

3

287

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [0.75, 2.11]

3.2 Sucralfate vs pantoprazole

1

137

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.25, 1.68]

4 All‐cause mortality in hospital Show forest plot

2

278

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.46, 1.37]

4.1 Sucralfate vs omeprazole

1

141

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.49, 1.91]

4.2 Sucralfate vs pantoprazole

1

137

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.21, 1.45]

5 Duration of ICU stay Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 Sucralfate vs omeprazole

2

217

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐1.68, 1.70]

6 Duration of intubation Show forest plot

3

354

Mean Difference (IV, Fixed, 95% CI)

‐0.16 [‐1.61, 1.28]

6.1 Sucralfate vs omeprazole

2

217

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐1.56, 1.60]

6.2 Sucralfate vs pantoprazole

1

137

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐4.69, 2.49]

7 Number of participants requiring blood transfusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Sucralfate vs omeprazole

1

70

Risk Ratio (M‐H, Fixed, 95% CI)

5.91 [0.29, 118.78]

8 Adverse events of interventions Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

8.1 Fever

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.70, 0.94]

8.2 Leucocytosis

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.55, 0.80]

8.3 Sudden purulent sputum

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.38, 1.86]

8.4 Sudden cough or aggravation of coughing

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.07, 0.79]

8.5 Dyspnoea

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.54, 0.87]

8.6 Rales or bronchial sounds

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.31 [0.19, 0.51]

8.7 Aggravation of blood gas exchange

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.49, 1.18]

8.8 Change in sputum quality

1

137

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.13, 0.40]

Figuras y tablas -
Comparison 22. Sucralfate versus proton pump inhibitors
Comparison 23. Sucralfate versus bioflavonoids

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Number of participants requiring blood transfusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 23. Sucralfate versus bioflavonoids
Comparison 24. Total parenteral nutrition (TPN) versus any other intervention + TPN

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 TPN vs ranitidine + TPN

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.05, 12.14]

1.2 TPN vs sucralfate + TPN

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.03, 3.26]

2 All‐cause mortality in ICU Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 TPN vs ranitidine + TPN

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.41, 3.09]

2.2 TPN vs sucralfate + TPN

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.26, 1.52]

3 Duration of intubation Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 TPN vs ranitidine + TPN

1

54

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐9.53, 5.53]

3.2 TPN vs sucralfate + TPN

1

49

Mean Difference (IV, Fixed, 95% CI)

3.0 [‐1.50, 7.50]

Figuras y tablas -
Comparison 24. Total parenteral nutrition (TPN) versus any other intervention + TPN
Comparison 25. Bowel stimulation versus no prophylaxis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 25. Bowel stimulation versus no prophylaxis
Comparison 26. Nasojejunal nutrition versus nasogastric nutrition

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Clinically important upper GI bleeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Nosocomial pneumonia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 All‐cause mortality in hospital Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4 Adverse events of interventions Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 26. Nasojejunal nutrition versus nasogastric nutrition
Comparison 27. Enteral plus parenteral nutrition versus other nutrition regimens

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Nosocomial pneumonia Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.44, 1.40]

1.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.29, 1.25]

1.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.47, 3.33]

2 All‐cause mortality in hospital Show forest plot

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.20 [0.06, 0.60]

2.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.05, 1.30]

2.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.15 [0.03, 0.74]

3 Duration of ICU stay Show forest plot

1

120

Mean Difference (IV, Fixed, 95% CI)

‐5.98 [‐8.81, ‐3.16]

3.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Mean Difference (IV, Fixed, 95% CI)

‐3.81 [‐7.59, ‐0.03]

3.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Mean Difference (IV, Fixed, 95% CI)

‐8.72 [‐12.97, ‐4.47]

4 Duration of intubation Show forest plot

1

120

Mean Difference (IV, Fixed, 95% CI)

‐7.37 [‐9.29, ‐5.45]

4.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Mean Difference (IV, Fixed, 95% CI)

‐4.17 [‐6.96, ‐1.38]

4.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Mean Difference (IV, Fixed, 95% CI)

‐10.24 [‐12.88, ‐7.60]

5 Adverse events ‐ stress ulcer Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.36, 1.33]

5.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.38, 3.45]

5.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.23, 1.20]

6 Adverse events ‐ diarrhoea Show forest plot

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.42 [0.17, 1.02]

6.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.17 [0.05, 0.59]

6.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

1.42 [0.35, 5.73]

7 Adverse events ‐ pyaemia Show forest plot

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.37, 2.09]

7.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

4.11 [0.87, 19.41]

7.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.37 [0.11, 1.21]

8 Adverse events ‐ intracranial infection Show forest plot

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.15, 1.25]

8.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.19, 3.63]

8.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.23 [0.05, 1.15]

9 Adverse events ‐ hypoproteinaemia Show forest plot

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.11 [0.04, 0.27]

9.1 Enteral plus parenteral nutrition vs enteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.20 [0.06, 0.72]

9.2 Enteral plus parenteral nutrition vs parenteral nutrition

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.04 [0.01, 0.19]

Figuras y tablas -
Comparison 27. Enteral plus parenteral nutrition versus other nutrition regimens