Summary of findings 3. Proton pump inhibitors compared with placebo or no prophylaxis for preventing upper gastrointestinal bleeding in people admitted to intensive care units.
| Proton pump inhibitors 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: proton pump inhibitors 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 proton pump inhibitors | |||||
|
Clinically important upper GI bleeding Follow‐up: not reported |
Study population | RR 0.63 (0.18 to 2.22) | 237 (3 RCTs) | ⊕⊕⊝⊝ LOWa,b | ||
| 49 per 1000 | 31 per 1000 (9 to 108) | |||||
|
Nosocomial pneumonia Follow‐up: not reported |
Study population | RR 1.24 (0.77 to 1.98) | 227 (2 RCTs) | ⊕⊕⊝⊝ LOWa,c | ||
| 188 per 1000 | 233 per 1000 (145 to 372) | |||||
|
All‐cause mortality in ICU Follow‐up: not reported |
Study population | RR 1.09 (0.60 to 1.99) | 258 (3 RCTs) | ⊕⊕⊝⊝ LOWa,c | ||
| 134 per 1000 | 146 per 1000 (80 to 266) | |||||
|
Duration of ICU stay Follow‐up: not reported |
Mean duration of ICU stay ranged from 8.6 to 11.1 days | MD 0.03 days lower (1.63 days lower to 1.58 days higher) | ‐ | 227 (2 RCTs) | ⊕⊕⊝⊝ LOWa,c | |
| Number of participants requiring blood transfusion | Not reported | |||||
| 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). 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 imprecision because 95% CI was compatible with benefit and harm.
bDowngraded by one level for risk of bias because of high risk of performance bias in one study and high risk of attrition bias in one study.
cDowngraded by one level for risk of bias because of high risk of performance bias in one study.