ABSTRACT
BACKGROUND: Critically ill children are at risk of stress-induced gastrointestinal ulceration. Acid suppressants are frequently used in intensive care units even though there is uncertainty about the benefits and harms. With this systematic review, we aimed to assess patient-important benefits and harms of stress ulcer prophylaxis (SUP) in children in intensive care. METHODS: We conducted the review according to the PRISMA statement, the Cochrane Handbook, and GRADE, using conventional meta-analysis and trial sequential analysis (TSA). We included randomised clinical trials comparing SUP with histamine-2-receptor antagonists or proton pump inhibitors vs placebo/no prophylaxis in children admitted for intensive care. Primary outcomes were all-cause mortality and overt gastrointestinal bleeding. Secondary outcomes were serious adverse events, hospital-acquired pneumonia, Clostridium difficile enteritis, myocardial ischemia, acute kidney injury and quality of life. RESULTS: We included a total of seven trials (n = 504) with eight trial comparisons. We found no statistically significant difference in all-cause mortality (relative risk (RR) 1.43, 95% confidence interval (CI) 0.86-2.37), overt gastrointestinal bleeding (RR 0.75, 95% CI 0.42-1.35) or hospital-acquired pneumonia (RR 1.18, 95% CI 0.77-1.82) between SUP vs placebo/no prophylaxis. No trials reported on remaining secondary outcomes. TSA was unable to draw firm conclusions for all outcomes and certainty of evidence for all outcomes was "very low." CONCLUSIONS: We found no difference in all-cause mortality, overt gastrointestinal bleeding or hospital-acquired pneumonia in children in intensive care receiving acid suppressants compared with placebo/no prophylaxis. However, the quantity and quality of evidence was very low with no firm evidence for benefit or harm.
Subject(s)
Peptic Ulcer , Quality of Life , Child , Critical Illness , Histamine H2 Antagonists/therapeutic use , Humans , Intensive Care UnitsABSTRACT
BACKGROUND: It is a common prejudice that anaesthetic doctors are believed to have high coffee consumption. In this study, we aimed to assess the association between coffee drinking and work satisfaction among Scandinavian anaesthesiologists. We hypothesised that coffee consumption was positively correlated with work satisfaction. METHODS: We invited anaesthesiologists attending the 34th congress of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine in Malmö, Sweden, September 2017 to participate in a paper-based survey. We collected data on characteristics of the respondents, coffee drinking and work satisfaction, and compared coffee vs non-coffee drinkers with regard to work satisfaction scored on a modified Wong-Baker Faces Pain Rating Scale (Visual Analogue Scale from 0 to 10). RESULTS: A total of 271 anaesthesiologists participated in the survey, of which 265 (97.7%) of the questionnaires contained valid data. Some 143 (54.0%) of the respondents were women, the median (interquartile range, IQR) age was 41.0 (35.0-49.5) years, and 242 (91.3%) were coffee drinkers. Coffee drinkers consumed median 4.0 (IQR: 2.5-5.0) cups of coffee daily. Overall work satisfaction was median 8 (IQR: 8-9), with no difference between respondents drinking coffee and those who did not (median 8 (IQR: 8-9) vs 8 (IQR: 8-9), Wilcoxon rank sum test, P = 0.62). Also, we found no association between work satisfaction and the number of cups of coffee consumed daily (r2 = 0.005, P = 0.24). CONCLUSION: In this survey, we found high work satisfaction among Scandinavian anaesthesiologists, with no difference between coffee and non-coffee drinkers.
