Summary of findings 2. H2 receptor antagonists compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units.
| H2 receptor antagonists compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units | ||||||
| Patient or population: people admitted to intensive care units Setting: ICU Intervention: H2 receptor antagonists Comparison: placebo or no prophylaxis | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo or no prophylaxis | Risk with H2 receptor antagonists | |||||
|
Clinically important upper GI bleeding Follow‐up: 15 days/weeks† |
Study population | RR 0.50 (0.36 to 0.70) | 2149 (24 RCTs) | ⊕⊕⊕⊝ MODERATEa | ||
| 182 per 1000 | 91 per 1000 (65 to 127) | |||||
|
Nosocomial pneumonia Follow‐up: 48 hours after extubation‡ |
Study population | RR 1.12 (0.85 to 1.48) | 945 (8 RCTs) | ⊕⊕⊝⊝ LOWb,c | ||
| 146 per 1000 | 164 per 1000 (124 to 216) | |||||
|
All‐cause mortality in ICU Follow‐up: 4 weeks§ |
Study population | RR 1.12 (0.88 to 1.42) | 1428 (14 RCTs) | ⊕⊕⊝⊝ LOWb,d | ||
| 145 per 1000 | 162 per 1000 (127 to 205) | |||||
|
Duration of ICU stay Follow‐up: not reported |
Mean duration of ICU stay ranged from 8.6 to 11.1 days | MD 0.73 days higher (0.92 days lower to 2.38 days higher) | ‐ | 230 (2 RCTs) | ⊕⊕⊝⊝ LOWb,e | |
|
Number of participants requiring blood transfusions Follow‐up: 48 hours after extubationǁ |
Study population | RR 0.58 (0.36 to 0.95) | 655 (7 RCTs) | ⊕⊕⊕⊝ MODERATEf | ||
| 112 per 1000 | 65 per 1000 (40 to 107) | |||||
| Serious adverse events | Not reported | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
†Duration of follow‐up reported in four studies. ‡Duration of follow‐up reported in two studies. §Duration of follow‐up reported in five studies. ǁDuration of follow‐up reported in one study. CI: confidence interval; GI: gastrointestinal; ICU: intensive care unit; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in eight studies, high risk of attrition bias in two studies, high risk of reporting bias in four studies, and high risk of other biases in three studies.
bDowngraded by one level for imprecision because 95% CI was compatible with benefit and harm.
cDowngraded by one level for risk of bias because of high risk performance bias in three studies and high risk of attrition bias in one study.
dDowngraded by one level for risk of bias because of high risk of performance bias in three studies and high risk of attrition bias in one study.
eDowngraded by one level for risk of bias because of high risk of performance bias in one study.
fDowngraded by one level for risk of bias because of high risk of selection bias in one study, high risk of performance bias in two studies, high risk of attrition bias in one study, and high risk of other biases in one study.