Ventilator-Associated Pneumonia in Patients Using Proton Pump Inhibitors Versus Histamine H2 Receptor Antagonists: A Systematic Review and Meta-Analysis.
Background: The common use of proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RA) in critically ill patients may increase the incidence of pneumonia associated with mechanical ventilation caused by alkalinization of gastric pH and microaspirations. Given the differences in the...
| Publicado en: | Respiratory Care Vol. 70; no. 9; pp. 1159 - 1168 |
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| Autores principales: | , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Sep2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=187691960&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 187691960 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Sep2025 vid: 70 iid: 9 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 187691960 187691960 187691960 10.1089/respcare.12397 187691960 ppf: 1159 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Ventilator-Associated Pneumonia in Patients Using Proton Pump Inhibitors Versus Histamine H2 Receptor Antagonists: A Systematic Review and Meta-Analysis. aug: au: Alves Filho, Francisco Willamy Pedrosa Lima, Nágila Alves Mendes, Beatriz Ximenes Sales, Ivna Cavalcante Barros affil: Dr. Alves Filho is affiliated with Department of Medicine, Federal University of Ceará, Sobral, Brazil. sug: subj: Pneumonia, Ventilator-Associated Epidemiology Proton Pump Inhibitors Therapeutic Use Histamine H2 Antagonists Therapeutic Use Length of Stay Hospital Mortality Treatment Duration Respiration, Artificial Time Human Systematic Review Meta Analysis PubMed Embase Cochrane Library Comparative Studies Intensive Care Units Descriptive Statistics Data Analysis Software Odds Ratio Confidence Intervals Cause of Death Critically Ill Patients Checklists Male Female Middle Age Middle Aged: 45-64 years Male Female ab: Background: The common use of proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RA) in critically ill patients may increase the incidence of pneumonia associated with mechanical ventilation caused by alkalinization of gastric pH and microaspirations. Given the differences in the mechanisms of action of these drugs, we propose to evaluate, through a systematic review and meta-analysis, the incidence of ventilator-associated pneumonia (VAP) in this patient profile. Methods: We systematically searched PubMed, Embase, and Cochrane, and we included articles that evaluated subjects admitted to the ICU using mechanical ventilation for >48 hours, comparing PPI versus H2RA, to evaluate VAP as the primary outcome. Review Manager 5.4.1 was used for statistical analysis, and heterogeneity was examined with the I2 statistic. We use Mantel–Haenszel as a statistical test. Results: A total of 33,471 subjects from 4 randomized controlled trials (RCTs) and 5 nonrandomized cohorts were included. In total, 16,515 (49.34%) subjects received PPI and 16,956 (50.65%) received H2RA. The average age of the population was 56 years. There was no difference in the incidence of VAP when using PPI versus H2RA (5.8% vs 6.1%; odds ratio [OR] 1.04, 95% CI 0.81–1.34, P =.77; I2 = 69%) or all-cause mortality (31.88% vs 20.35%; OR 1.30, 95% CI 0.96–1.76, P =.09; I2 = 93%) between groups. In a subanalysis of RCT-only data (469 subjects), the use of PPI or H2RA was also no different in the incidence of VAP (26.52% vs 20.50%; OR 1.41, 95% CI 0.50–3.98; P =.52; I2 = 76%). Conclusions: The data show that the use of PPI or H2RA was indifferent to the incidence of VAP in subjects receiving mechanical ventilation for more than 48 hours. Furthermore, there was also no difference between the groups in relation to all-cause mortality, hospital stay, ICU stay, or duration of mechanical ventilation. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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