Table 2.
Summary of randomized trials on gastroprotection in neurocritical patients
|
No
|
Ref.
|
Year
|
Study population
|
N
|
Intervention arm 1 (n)
|
Intervention arm 2 (n)
|
Intervention arm 3 (n)
|
Endpoints
|
Findings
|
| 1 | Halloran et al[28] | 1980 | Severe TBI patients | 50 | Cimetidine (26) | No prophylaxis (24) | - | GIB (NGT aspirate positive for blood) | Overt GIB significantly lower in arm 1 compared to arm 2 |
| 2 | Reusser et al[25] | 1990 | TBI and surgically managed ICH patients | 40 | Ranitidine (21) | No prophylaxis (19) | - | Gastric pH > 4, endoscopic findings of ulcer, blood in NGT aspirates | No difference in rate of stress ulcers or GIB between both arms |
| 3 | Metz et al[9] | 1994 | TBI patients | 167 | Ranitidine (86) | No prophylaxis (81) | - | GIB (NGT aspirate positive for blood or malena/hematochezia). Nosocomial pneumonia | Overt GIB significantly lower in arm 1 compared to arm 2. No difference in rates of pneumonia |
| 4 | Burgess et al[27] | 1995 | TBI patients | 34 | Ranitidine (16) | No prophylaxis (18) | - | GIB (NGT aspirate positive for blood or malena/hematochezia) | Overt GIB significantly lower in arm 1 compared to arm 2 |
| 5 | Chan et al[26] | 1995 | Non traumatic neurosurgical patients | 101 | Ranitidine (48) | No prophylaxis (52) | - | Serial endoscopic assessment to determine bleeding requiring transfusion or surgery | Overt GIB significantly lower in arm 1 compared to arm 2 |
| 6 | Misra et al[7] | 2005 | ICH | 141 | Ranitidine (45) | Sucralfate (49) | No prophylaxis (47) | GIB (hematemesis, NGT aspirate positive for blood or malena/hematochezia), 1 month mortality | No difference in GIB or 1 month mortality between arm 1, arm 2 compared to arm 3 |
| 7 | Brophy et al[34] | 2010 | All patients admitted to the neurosurgery ICU | 51 | Lansoprazole (28) | Famotidine (23) | - | The pH ≥ 4 and % of time gastric residuals was < 28 mL | Arm 1 achieved pH ≥ 4 and fewer heme-positive aspirates more often than arm 2 only on day 1 |
| 8 | Liu et al[37] | 2013 | Surgically treated ICH patients | 165 | Omeprazole (58) | Cimetidine (54) | No prophylaxis (53) | UGIB hematemesis, aspiration of coffee-ground material from NGT or positive gastric occult blood or fecal occult blood testing, with or without hemodynamic instability from gross bleeding needing transfusion). Nosocomial pneumonia incidence | Lower rate of UGIB in arm 1 compared to arm 2 and 3. No difference in rate of nosocomial pneumonia |
| 9 | Lee et al[35] | 2014 | Neuro ICU patients admitted post-op or Canonical Variates Analysis management | 60 | Esomeprazole (30) | Famotidine (30) | - | Overt GIB and VAP | 1 patient in arm 2 developed GIB and 1 from each arm developed VAP |
| 10 | Senapathi et al[36] | 2019 | TBI patients with Glasgow coma scale < 10 | 56 | Omeprazole (28) | Ranitidine (28) | - | Time to gastric pH > 3.5-5.0 and occult from NGT aspirates | No significant difference in endpoints between both arms |
GIB: Gastrointestinal bleeding; ICH: Intracerebral hemorrhage; ICU: Intensive care unit; NGT: Nasogastric tube; TBI: Traumatic brain injury; UGIB: Upper gastrointestinal bleeding; VAP: Velocity average path.