{"title":"质子泵抑制剂与组胺H2受体拮抗剂对呼吸机相关肺炎患者的影响：一项系统综述和荟萃分析","authors":"Francisco Willamy Pedrosa Alves Filho, Nágila Alves Lima, Beatriz Ximenes Mendes, Ivna Cavalcante Barros Sales","doi":"10.1089/respcare.12397","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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>I</i><sup>2</sup> statistic. We use Mantel-Haenszel as a statistical test. <b>Results:</b> 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, <i>P</i> = .77; <i>I</i><sup>2</sup> = 69%) or all-cause mortality (31.88% vs 20.35%; OR 1.30, 95% CI 0.96-1.76, <i>P</i> = .09; <i>I</i><sup>2</sup> = 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; <i>P</i> = .52; <i>I</i><sup>2</sup> = 76%). <b>Conclusions:</b> 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.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Ventilator-Associated Pneumonia in Patients Using Proton Pump Inhibitors Versus Histamine H2 Receptor Antagonists: A Systematic Review and Meta-Analysis.\",\"authors\":\"Francisco Willamy Pedrosa Alves Filho, Nágila Alves Lima, Beatriz Ximenes Mendes, Ivna Cavalcante Barros Sales\",\"doi\":\"10.1089/respcare.12397\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> 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. <b>Methods:</b> 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>I</i><sup>2</sup> statistic. We use Mantel-Haenszel as a statistical test. <b>Results:</b> 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, <i>P</i> = .77; <i>I</i><sup>2</sup> = 69%) or all-cause mortality (31.88% vs 20.35%; OR 1.30, 95% CI 0.96-1.76, <i>P</i> = .09; <i>I</i><sup>2</sup> = 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; <i>P</i> = .52; <i>I</i><sup>2</sup> = 76%). <b>Conclusions:</b> 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.</p>\",\"PeriodicalId\":21125,\"journal\":{\"name\":\"Respiratory care\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-06-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Respiratory care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1089/respcare.12397\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Respiratory care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/respcare.12397","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景：危重患者普遍使用质子泵抑制剂（PPIs）和组胺2受体拮抗剂（H2RA）可能会增加胃pH碱化和微吸气引起的机械通气相关肺炎的发生率。鉴于这些药物作用机制的差异，我们建议通过系统回顾和荟萃分析来评估该患者中呼吸机相关性肺炎（VAP）的发生率。方法：我们系统地检索PubMed， Embase和Cochrane，我们纳入了评估使用机械通气进入ICU的受试者bbbb48小时的文章，比较PPI和H2RA，以评估VAP作为主要结局。采用Review Manager 5.4.1进行统计分析，采用I2统计量检验异质性。我们使用Mantel-Haenszel作为统计检验。结果：共纳入4项随机对照试验（RCTs）和5项非随机队列的33471名受试者。共16515例（49.34%）患者接受PPI治疗，16956例（50.65%）患者接受H2RA治疗。人口的平均年龄为56岁。使用PPI与使用H2RA时VAP的发生率无差异(5.8% vs 6.1%；优势比[OR] 1.04, 95% CI 0.81-1.34, P = 0.77；I2 = 69%)或全因死亡率(31.88% vs 20.35%；或1.30,95% ci 0.96-1.76, p = 0.09；I2 = 93%)。在仅rct数据（469名受试者）的亚分析中，使用PPI或H2RA在VAP发生率方面也没有差异(26.52% vs 20.50%；或1.41,95% ci 0.50-3.98；P = .52；I2 = 76%)。结论：数据显示，在机械通气超过48小时的受试者中，使用PPI或H2RA对VAP的发生率无关。此外，两组之间在全因死亡率、住院时间、ICU住院时间或机械通气持续时间方面也没有差异。
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 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.
期刊介绍：
RESPIRATORY CARE is the official monthly science journal of the American Association for Respiratory Care. It is indexed in PubMed and included in ISI''s Web of Science.
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