Systematic review of prophylaxis

The positive results of randomized trials in stress ulcer prophylaxis have previously led to recommendations that prophylaxis be administered to a large proportion of critically ill patients. However, individually, these studies have not established whether these agents decrease clinically important bleeding, nor have they consistently elucidated the relative merits of different prophylactic regimens.

Several systematic reviews have evaluated drugs for stress ulcer prophylaxis drugs. By gaining adequate power through combining results of different studies, one type of systematic review involving a statistical synthesis (meta-analysis) can resolve issues of therapeutic effectiveness. A recent meta-analysis has resolved discordances between these reviews, providing the current best estimates of the effect of various prophylactic regimens on bleeding, pneumonia, and mortality ( Cook.

etai 1996). The 61 articles identified reported studies of over 7000 critically ill patients. The following inclusion criteria were used to select studies:

1. randomized trials comparing one or more prophylactic drugs with each other or with an untreated control group;

2. the target population was critically ill patients;

3. the outcome measure was gastrointestinal bleeding, pneumonia, or death.

The common odds ratio, which is the weighted average of the individual study odds ratios calculated using the Mantel-Haenszel c 2 test, was used to interpret the results of this meta-analysis.

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