SynthesisCritical care (London, England)2015
Risks and benefits of stress ulcer prophylaxis in adult neurocritical care patients: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Critical care (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- Recommendations for Stress Ulcer Prophylaxis in Critically Ill Adults: A Contextualized Clinical Practice Guideline From the Saudi Critical Care Society and the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Endorsed by the Kuwait Anesthesia and Critical Care Society.Acta anaesthesiologica Scandinavica · 2026Guideline
- Summary of the best evidence for stress ulcer prophylaxis in critically ill patients.Frontiers in medicine · 2026Pooled it
- Dysregulated sympathovagal interplay contributes to gastric mucosal injury following subarachnoid hemorrhage.Frontiers in neuroscience · 2026Article
- Review
- Mind the gut: Navigating the complex landscape of gastroprotection in neurosurgical patients.World journal of gastroenterology · 2025Article
- Prophylactic proton pump inhibitor use and all-cause mortality in adult sepsis patients: a retrospective analysis based on the MIMIC-IV database.Frontiers in pharmacology · 2025Article
- Outcomes of patients with traumatic brain injury after stress ulcer prophylaxis: a retrospective multicenter study.Trauma surgery & acute care open · 2024Article
- Effect of electroacupuncture on the repair of stress ulcer injury in neurocritical patients: A randomized clinical trial.Frontiers in medicine · 2022Article
- A Retrospective Cohort Analysis of the Use of Enteral Nutrition Plus Pharmacologic Prophylaxis or Enteral Nutrition Alone.Hospital pharmacy · 2021Article
- A contemporary review of therapeutic and regenerative management of intracerebral hemorrhage.Annals of clinical and translational neurology · 2021Review
- Endoscopy Is Relatively Safe in Patients with Acute Ischemic Stroke and Gastrointestinal Hemorrhage.Digestive diseases and sciences · 2019Article
- [How important are proton pump inhibitors in the prevention of stress ulcers and stress-associated gastrointestinal bleeding in ICU patients?]Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2019Article
- Stress Ulcer Prophylaxis in Neurocritical Care.Neurocritical care · 2018Review
- Acid-Suppressive Therapy and Risk of Infections: Pros and Cons.Clinical drug investigation · 2017Review
- Gastric Ulcer Hemorrhage - a Potential Life-Threatening Complication of Intragastric Balloon Treatment of Obesity.Obesity facts · 2017Article
- Effective and safe proton pump inhibitor therapy in acid-related diseases - A position paper addressing benefits and potential harms of acid suppression.BMC medicine · 2016Review
- [Intensive care studies from 2015/2016].Der Anaesthesist · 2016Article
- Stress ulcer prophylaxis in adult neurocritical care patients--no firm evidence for benefit or harm.Critical care (London, England) · 2016Article
- Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionNeurocritical care patients are at high risk for stress-related upper gastrointestinal (UGI) bleeding. The aim of this meta-analysis was to evaluate the risks and benefits of stress ulcer prophylaxis (SUP) in this patient group.
methodsA systematic search of major electronic literature databases was conducted. Eligible studies were randomized controlled trials (RCTs) in which researchers compared the effects of SUP (with proton pump inhibitors or histamine 2 receptor antagonists) with placebo or no prophylaxis in neurocritical care patients. The primary outcome was UGI bleeding, and secondary outcomes were all-cause mortality and nosocomial pneumonia. Study heterogeneity was sought and quantified. The results were reported as risk ratios/relative risks (RRs) with 95 % confidence intervals (CIs).
resultsWe included 8 RCTs comprising an aggregate of 829 neurocritical care patients. Among these trials, one study conducted in a non-intensive care unit setting that did not meet our inclusion criteria was ultimately included based on further evaluation. All studies were judged as having a high or unclear risk of bias. SUP was more effective than placebo or no prophylaxis at reducing UGI bleeding (random effects: RR 0.31; 95 % CI 0.20-0.47; P < 0.00001; I (2) = 45 %) and all-cause mortality (fixed effects: RR 0.70; 95 % CI 0.50-0.98; P = 0.04; I (2) = 0 %). There was no difference between SUP and placebo or no prophylaxis regarding nosocomial pneumonia (random effects: RR 1.14; 95 % CI 0.67-1.94; P = 0.62; I (2) = 42 %). The slight asymmetry of the funnel plots raised the concern of small trial bias, and apparent heterogeneity existed in participants, interventions, control treatments, and outcome measures.
conclusionsIn neurocritical care patients, SUP seems to be more effective than placebo or no prophylaxis in preventing UGI bleeding and reducing all-cause mortality while not increasing the risk of nosocomial pneumonia. The robustness of this conclusion is limited by a lack of trials with a low risk of bias, sparse data, heterogeneity among trials, and a concern regarding small trial bias.
trial registrationInternational Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42015015802 . Date of registration: 6 Jan 2015.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.