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To examine the differential effect of stress ulcer prophylaxis on overt bleeding, clinically important bleeding, and mortality in critically ill patients. ⋯ Overt gastrointestinal bleeding in critically ill patients is reduced by prophylaxis with antacids or histamine-2-receptor antagonists. Histamine-2-receptor antagonists are more effective than antacids at decreasing overt bleeding and are more effective than no treatment at reducing the incidence of clinically important bleeding. Mortality rates in the intensive care unit are not decreased by stress ulcer prophylaxis.
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This article is a review and analysis of published and unpublished research on the efficacy of both dilute heparin solutions and normal saline solutions in flushing and maintaining the patency of vascular catheters. Twenty studies involving both intravenous and intraarterial catheters in pediatric and adult patients are summarized and analyzed both quantitatively and qualitatively. Thirteen studies that were conceptually similar were subjected to a meta-analysis; no significant difference in duration of patency was found between intravascular catheters flushed with saline solution and those flushed with a heparinized solution. Implications for changing practice based on research findings are discussed.
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To assess the effect of selective decontamination of the digestive tract on respiratory tract infections and survival of patients treated in an intensive care unit, we carried out a meta-analysis of clinical studies comparing patients treated with selective decontamination with untreated controls. From eleven trials (1489 patients), differences between observed and expected respiratory tract infections and mortality were compared, and odds ratios (ORs) calculated. Analysis was done according to study design. ⋯ By contrast, the mortality benefit was less clear. Studies with historical controls and randomised trials showed that mortality was not significantly different between treatment and control patients. The evidence from these studies is at best consistent with a very limited effect of selective decontamination of the digestive tract on survival of patients in the intensive care unit, despite a clear preventive effect on the occurrence of respiratory tract infections.
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Twenty trials (17 controlled and three observational cohort studies) on selective decontamination of the digestive tract (SDD) have been undertaken to date. SDD is defined as a technique which aims to eradicate carriage of disease-causing microorganisms by means of lethal oropharyngeal and faecal antimicrobial concentrations. The SDD concept and the criteria for the choice of the antimicrobials used in the SDD programme are explained. ⋯ Two recent trials describe the control of an outbreak with a multiresistant Klebsiella by SDD. There are three indications for the use of SDD so far: (i) in trauma patients; (ii) in certain elective surgical procedures including liver transplantation and oesophageal resection; and (iii) in control of outbreaks of ICU infection. Future lines of research may include a properly designed trial with mortality as endpoint and studies on the transfer of SDD from the ICU into the ward as part of prophylaxis in major surgery.
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Critical care medicine · Jul 1991
Meta Analysis Comparative StudySucralfate versus antacids or H2-antagonists for stress ulcer prophylaxis: a meta-analysis on efficacy and pneumonia rate.
Histamine2 (H2)-receptor antagonists and antacids have been the basic drugs for the prevention of stress bleeding in ICU patients during the past decade. Recently, drugs without major influence on gastric pH have been investigated in stress bleeding prophylaxis. Therefore, a meta-analysis (Mantel-Haenszel test) was undertaken to determine the efficacy of sucralfate in the prevention of macroscopically visible stress bleeding, as well as the influence of sucralfate on the frequency of pulmonary infections. ⋯ Sucralfate is an effective drug for the prevention of stress bleeding that minimizes the risk of nosocomial pneumonia in long-term ventilated ICU patients.