Vanderbilt University Medical Center Nashville, TN
Award: Presidential Poster Award
Aamir Saeed, MD1, Umar Abdul Rehman Khalid, MD2, Usama Qamar, MD2, Ijlal Akbar Ali, MD3 1Vanderbilt University Medical Center, Nashville, TN; 2King Edward Medical University, Lahore, Punjab, Pakistan; 3University of Oklahoma College of Medicine, Oklahoma City, OK
Introduction: Gastrointestinal bleeding is associated with higher mortality and longer stays in the intensive care units. Proton pump inhibitors (PPIs and histamine-2 receptor blockers (H2RBs) are widely used in the ICU for stress ulcer prophylaxis. There is a paucity of data on whether proton pump inhibitors are safe for stress ulcer prophylaxis in patients requiring mechanical ventilation. We conducted a meta-analysis of randomized controlled trials to evaluate this.
Methods: A comprehensive literature review was conducted using PubMed, Embase, Google Scholar, ClinicalTrials.gov, Scopus, and Web of Science Core Collection for randomized controlled trials comparing PPI versus non-PPI for stress ulcer prophylaxis in patients requiring mechanical ventilation, until June 14, 2024. Using the random-effects Mantel-Haenszel method, we calculated pooled risk ratios (RRs) and their corresponding 95% confidence intervals (CIs) for all dichotomous variable heterogeneity was assessed using the I² statistic.
Results: Nine studies comprising 28155 patients (PPI 14085 and non-PPI 14070) met the inclusion criteria. The mean age was 55.5 years, 64% of patients were men. Patients who received PPI therapy had fewer cases of upper GI bleeding as compared to the control group 1.3% vs 2.2%, and pooled rates were RR (95%CI): 0.45 (0.27, 0.74), p=0.002 I²=63% (Figure 1A). However, the relative risk for mortality RR (95%CI): 1.03 (0.93, 1.14), p=0.60, Ventilator-associated pneumonia, RR (95%CI): 0.98 (0.89, 1.09), p=0.75, and C. diff RR (95%CI): 1.14 (0.50, 2.58), p=0.76 was similar between PPI and non-PPI groups. (Figure 1B, C, D).
Discussion: Stress ulcer prophylaxis with proton pump inhibitors in patients requiring mechanical ventilation led to a lower and statistically significant incidence of upper gastrointestinal bleeding. There was, however, no improvement in mortality. Importantly, there was no significant increase in the incidence of ventilator-associated pneumonia, and C. diff between the groups.
Figure: Comparison of UGIB (Figure 1A), mortality (Figure 1B), VAP (Figure 1C), and C.diff (Figure 1D) between the groups.
Disclosures:
Aamir Saeed indicated no relevant financial relationships.
Umar Abdul Rehman Khalid indicated no relevant financial relationships.
Usama Qamar indicated no relevant financial relationships.
Ijlal Akbar Ali indicated no relevant financial relationships.
Aamir Saeed, MD1, Umar Abdul Rehman Khalid, MD2, Usama Qamar, MD2, Ijlal Akbar Ali, MD3. P0735 - Stress Ulcer Prophylaxis in Patients Requiring Mechanical Ventilation: A Meta-Analysis of Randomized Controlled Trials, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
