Ventilator-Associated Pneumonia in Patients Using Proton Pump Inhibitors Versus Histamine H2 Receptor Antagonists: A Systematic Review and Meta-Analysis
Abstract
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 I 2 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; I 2 = 69%) or all-cause mortality (31.88% vs 20.35%; OR 1.30, 95% CI 0.96–1.76, P = .09; I 2 = 93%) between groups. In a subanalysis of RCT-only data (469 subjects), the use of PPI or H2RA was also no different in…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 33,471 participants or records.
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