Abstract：
OBJECTIVE: To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs).
METHODS: Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.
METHODS: Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included.
METHODS: The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP).
METHODS: The primary outcome was the prevention of clinically important upper GI bleeding.
RESULTS: We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding.The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.
CONCLUSIONS: Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients\' underlying conditions.
METHODS: Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.
METHODS: Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included.
METHODS: The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP).
METHODS: The primary outcome was the prevention of clinically important upper GI bleeding.
RESULTS: We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding.The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.
CONCLUSIONS: Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients\' underlying conditions.
摘要：
目的：评估药物干预预防重症监护病房（ICU）患者上消化道（GI）出血的有效性和安全性。
方法：使用Cochrane推荐的标准方法学程序进行系统评价和频繁的网络荟萃分析，以筛选记录，数据提取和分析。建议评估的分级，使用开发和评估(GRADE)方法来评估证据的确定性。
方法：纳入纳入ICU住院时间超过24小时的患者的随机对照试验。
方法：Cochrane肠道专业注册，Cochrane中央对照试验登记册（中央），MEDLINE,从2017年8月至2022年3月，搜索了Embase和拉丁美洲和加勒比健康科学信息数据库（LILACS）数据库。MEDLINE中的搜索于2023年4月更新。我们还检索了ClinicalTrials.gov和世界卫生组织国际临床试验注册平台（WHOICTRP）。
方法：主要结果是预防临床上重要的上消化道出血。
结果：我们纳入了123项研究，46996名参与者。西咪替丁（相对风险（RR）0.56，95％CI0.40至0.77，中度确定性），雷尼替丁(RR0.54，95%CI0.38至0.76，中等确定性)，抗酸剂(RR0.48，95%CI0.33至0.68，中等确定性)，硫糖铝(RR0.54,95%CI0.39~0.75,中度确定性)以及雷尼替丁和抗酸剂的组合(RR0.13,95%CI0.03~0.62,中度确定性)可能对预防上消化道出血有效。任何干预措施对预防医院内肺炎的影响，ICU或医院的全因死亡率，在ICU的停留时间，插管持续时间和(严重)不良事件尚不清楚.
结论：几种干预措施似乎可有效预防临床上重要的上消化道出血，而其他结局的证据有限。患者相关的益处和危害需要在考虑患者的基础条件下进行评估。
方法：使用Cochrane推荐的标准方法学程序进行系统评价和频繁的网络荟萃分析，以筛选记录，数据提取和分析。建议评估的分级，使用开发和评估(GRADE)方法来评估证据的确定性。
方法：纳入纳入ICU住院时间超过24小时的患者的随机对照试验。
方法：Cochrane肠道专业注册，Cochrane中央对照试验登记册（中央），MEDLINE,从2017年8月至2022年3月，搜索了Embase和拉丁美洲和加勒比健康科学信息数据库（LILACS）数据库。MEDLINE中的搜索于2023年4月更新。我们还检索了ClinicalTrials.gov和世界卫生组织国际临床试验注册平台（WHOICTRP）。
方法：主要结果是预防临床上重要的上消化道出血。
结果：我们纳入了123项研究，46996名参与者。西咪替丁（相对风险（RR）0.56，95％CI0.40至0.77，中度确定性），雷尼替丁(RR0.54，95%CI0.38至0.76，中等确定性)，抗酸剂(RR0.48，95%CI0.33至0.68，中等确定性)，硫糖铝(RR0.54,95%CI0.39~0.75,中度确定性)以及雷尼替丁和抗酸剂的组合(RR0.13,95%CI0.03~0.62,中度确定性)可能对预防上消化道出血有效。任何干预措施对预防医院内肺炎的影响，ICU或医院的全因死亡率，在ICU的停留时间，插管持续时间和(严重)不良事件尚不清楚.
结论：几种干预措施似乎可有效预防临床上重要的上消化道出血，而其他结局的证据有限。患者相关的益处和危害需要在考虑患者的基础条件下进行评估。
