• Mustafa Alquraini, Fayez Alshamsi, Møller Morten Hylander MH Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark., Emilie Belley-Cote, Saleh Almenawer, Roman Jaeschke, Robert MacLaren, and Waleed Alhazzani.
• Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, L8S 4K1, Canada.
• J Crit Care. 2017 Aug 1; 40: 21-30.

PurposeTo determine the impact of using sucralfate versus H2RAs for SUP on patient important outcomes.Materials And MethodsWe searched CENTRAL, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through June 2016 for randomized controlled trials (RCTs) comparing sucralfate to H2RAs for SUP in adult critically ill patients.Results21 RCTs enrolling 3121 patients met inclusion criteria. There was no significant difference between sucralfate compared to H2RAs in the risk of clinically important GI bleeding (risk ratio [RR] 1.19; 95% CI [confidence interval] 0.79, 1.80; P=0.42; I2=0%; low quality evidence). However, there was a statistically significant lower risk of ICU acquired pneumonia with sucralfate compared to H2RAs (RR 0.84; 95% CI 0.72, 0.98; P=0.03; I2=0%; moderate quality evidence). Sucralfate did not significantly affect the risk of death (RR 0.95; 95% CI 0.82, 1.10; P=0.51; I2=0%; high quality evidence), or duration of ICU stay in days (mean difference-0.39; 95% CI [-1.12, 0.34]; P=0.29; I2=0%; moderate quality evidence). Trial sequential analysis adjusted estimates were consistent with conventional estimates.ConclusionModerate quality evidence suggests that sucralfate reduced ICU acquired pneumonia compared to H2RAs in adult critically ill patients, with no significant impact on GI bleeding or death.Copyright © 2017 Elsevier Inc. All rights reserved.

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