Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010;14(5):R194.
doi: 10.1186/cc9312. Epub 2010 Oct 29.

Effect of histamine-2-receptor antagonists versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients: a meta-analysis of 10 randomized controlled trials

Jiahao Huang  1 , Yunfei Cao, Cun Liao, Liucheng Wu, Feng Gao
Affiliations
Meta-Analysis

Effect of histamine-2-receptor antagonists versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients: a meta-analysis of 10 randomized controlled trials

Jiahao Huang et al. Crit Care. 2010.

Abstract

Introduction: We conducted a meta-analysis in order to investigate the effect of histamine-2-receptor antagonists (H2RA) versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients in the intensive care unit (ICU).

Methods: A systematic literature search of Medline, EMBASE, Cochrane Central Register of Controlled Trials (1966 to January 2010) was conducted using specific search terms. A review of Web of Science and a manual review of references were also performed. Eligible studies were randomized control trials (RCTs) that compared H2RA and sucralfate for the prevention of stress ulcer in mechanically ventilated patients. Main outcome measures were rates of overt bleeding, clinically important gastrointestinal (GI) bleeding, ventilator-associated pneumonia, gastric colonization and ICU mortality.

Results: Ten RCTs with 2,092 participants on mechanical ventilation were identified. Meta-analysis showed there was a trend toward decreased overt bleeding when H2RA was compared with sucralfate (OR = 0.87, 95% CI: 0.49 to 1.53). A total of 12 clinically important GI bleeding events occurred among 667 patients (1.8%) in the H2RA group compared with 26 events among 673 patients (3.9%) in the sucralfate groups. Prophylaxis with sucralfate decreased the incidence of gastric colonization (OR = 2.03, 95% CI: 1.29 to 3.19) and ventilator-associated pneumonia (OR = 1.32, 95% CI: 1.07 to 1.64). Subgroup analysis showed H2RA was not superior to sucralfate in reducing early-onset pneumonia (OR = 0.62, 95%CI: 0.36 to 1.07) but had a higher late-onset pneumonia rate (OR = 4.36, 95%CI: 2.09 to 9.09) relative to sucralfate. No statistically significant reduction was observed in mortality of ICU between groups (OR = 1.08, 95% CI: 0.86 to 1.34).

Conclusions: In patients with mechanical ventilation, H2RA resulted in no differential effectiveness in treating overt bleeding, but had higher rates of gastric colonization and ventilator-associated pneumonia. Additional RCTs of stress ulcer prophylaxis with H2RA and sucralfate are needed to establish the net benefit and risks of adverse effect in mechanically ventilated patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Overt bleeding of histamine-2-receptor antagonists (H2RA) versus sucralfate. Fixed-effects model of odds ratio (95% confidence interval, or CI) of overt bleeding associated with H2RA compared with sucralfate is shown.
Figure 3
Figure 3
Ventilator-associated pneumonia of histamine-2-receptor antagonists (H2RA) versus sucralfate. Fixed-effects model of odds ratio (95% confidence interval, or CI) of ventilator-associated pneumonia associated with H2RA compared with sucralfate is shown.
Figure 4
Figure 4
Intensive care unit mortality of histamine-2-receptor antagonists (H2RA) versus sucralfate. Fixed-effects model of odds ratio (95% confidence interval, or CI) of intensive care unit mortality associated with H2RA compared with sucralfate is shown.
Figure 5
Figure 5
Publication bias of the meta-analysis. Publication bias for the outcome of ventilator-associated pneumonia in studies of the effects of histamine-2-receptor antagonists versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients is shown. s.e., standard error.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kamada T, Fusamoto H, Kawano S, Noguchi M, Hiramatsu K. Gastrointestinal bleeding following head injury: a clinical study of 433 cases. J Trauma. 1977;17:44–47. doi: 10.1097/00005373-197701000-00006. - DOI - PubMed
    1. Schuster DP, Rowley H, Feinstein S, McGue MK, Zuckerman GR. Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med. 1984;76:623–630. doi: 10.1016/0002-9343(84)90286-9. - DOI - PubMed
    1. Lacroix J, Nadeau D, Laberge S, Gauthier M, Lapierre G, Farrell CA. Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit. Crit Care Med. 1992;20:35–42. doi: 10.1097/00003246-199201000-00013. - DOI - PubMed
    1. Cook DJ, Laine LA, Guyatt GH, Raffin TA. Nosocomial pneumonia and the role of gastric pH. A meta-analysis. Chest. 1991;100:7–13. doi: 10.1378/chest.100.1.7. - DOI - PubMed
    1. Ben-Menachem T, McCarthy BD, Fogel R, Schiffman RM, Patel RV, Zarowitz BJ, Nerenz DR, Bresalier RS. Prophylaxis for stress-related gastrointestinal hemorrhage: a cost effectiveness analysis. Crit Care Med. 1996;24:338–345. doi: 10.1097/00003246-199602000-00026. - DOI - PubMed

Publication types

MeSH terms