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  1. Article ; Online: Prevention of upper gastrointestinal bleeding in critical illness.

    Krag, Mette / Alhazzani, Waleed / Møller, Morten Hylander

    Intensive care medicine

    2023  Volume 49, Issue 3, Page(s) 334–336

    MeSH term(s) Humans ; Critical Illness ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/prevention & control
    Language English
    Publishing date 2023-01-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-022-06959-9
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  2. Article ; Online: Use of vasoactive agents in non-cardiac surgery: Protocol for a scoping review.

    Baekgaard, Emilie S / Møller, Morten Hylander / Vester-Andersen, Morten / Krag, Mette

    Acta anaesthesiologica Scandinavica

    2022  Volume 67, Issue 1, Page(s) 120–122

    Abstract: Background: An increasing number of patients undergo surgical procedures worldwide each year, and despite advances in quality and care, morbidity and mortality rates remain high. Perioperative hypotension is a well-described condition, and is associated ...

    Abstract Background: An increasing number of patients undergo surgical procedures worldwide each year, and despite advances in quality and care, morbidity and mortality rates remain high. Perioperative hypotension is a well-described condition, and is associated with adverse outcomes. Both fluids and vasoactive agents are commonly used to treat hypotension, however, whether one vasoactive agent is preferable over another has yet to be explored.
    Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement, we plan to conduct a scoping review of studies assessing the use of vasoactive agents in patients undergoing non-cardiac surgery. We will provide an overview of indications, agents used and outcomes assessed. We will assess and report the certainty of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
    Results: We will provide descriptive analyses of the included studies accompanied by tabulated results.
    Conclusion: The outlined scoping review will provide a summary of the body of evidence on the use of vasoactive agents in the non-cardiac surgical population.
    MeSH term(s) Humans ; Hypotension/drug therapy ; Systematic Reviews as Topic ; Review Literature as Topic
    Language English
    Publishing date 2022-10-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.14153
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  3. Article ; Online: Use of prokinetic agents in hospitalised adult patients: Protocol for a scoping review.

    Crone, Vera / Møller, Morten Hylander / Perner, Anders / Alhazzani, Waleed / Krag, Mette

    Acta anaesthesiologica Scandinavica

    2022  Volume 66, Issue 8, Page(s) 1024–1026

    Abstract: Background: Gastrointestinal motility is an important contributor to the effective uptake of water and nutrition. However, it is often impaired in acutely ill hospitalised patients. Amongst other indications, prokinetic agents are used to improve GI ... ...

    Abstract Background: Gastrointestinal motility is an important contributor to the effective uptake of water and nutrition. However, it is often impaired in acutely ill hospitalised patients. Amongst other indications, prokinetic agents are used to improve GI motility, but the body of evidence is not well described. Accordingly, we aim to systematically describe and explore the body of evidence on the use of prokinetic agents in hospitalised adults.
    Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement, we plan to conduct a scoping review of studies assessing the use of prokinetic agents, for any indication, in hospitalised adults. We plan to assess study design, population, agents, indications and outcomes across included studies. When applicable, we plan to assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
    Results: We plan to provide descriptive analyses of the included studies accompanied by tabulated results and characterise knowledge gaps.
    Conclusion: The outlined scoping review will provide a summary of the body of evidence on the use, indications, effects and side effects of prokinetic agents in hospitalised adults.
    MeSH term(s) Adult ; Humans ; Research Design ; Systematic Reviews as Topic
    Language English
    Publishing date 2022-06-22
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.14099
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  4. Article ; Online: Stress Ulcer Prophylaxis-Friend or Foe?

    Krag, Mette / Møller, Morten Hylander

    Critical care medicine

    2017  Volume 45, Issue 7, Page(s) 1241–1242

    MeSH term(s) Critical Illness ; Humans ; Pantoprazole ; Peptic Ulcer ; Pilot Projects ; Ulcer
    Chemical Substances Pantoprazole (D8TST4O562)
    Language English
    Publishing date 2017-06-16
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000002489
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  5. Article ; Online: Use of prokinetic agents in hospitalised adult patients: A scoping review.

    Crone, Vera / Møller, Morten Hylander / Baekgaard, Emilie Stokholm / Perner, Anders / Bytzer, Peter / Alhazzani, Waleed / Krag, Mette

    Acta anaesthesiologica Scandinavica

    2023  Volume 67, Issue 5, Page(s) 588–598

    Abstract: Background: Gastrointestinal motility is important for adequate uptake of fluids and nutrition but is often impaired in hospitalised patients. Prokinetic agents enhance gastrointestinal motility and are prescribed for many hospitalised patients. In this ...

    Abstract Background: Gastrointestinal motility is important for adequate uptake of fluids and nutrition but is often impaired in hospitalised patients. Prokinetic agents enhance gastrointestinal motility and are prescribed for many hospitalised patients. In this scoping review, we aimed to systematically describe the body of evidence on the use of prokinetic agents in hospitalised patients. We hypothesised, that the body of evidence would be limited and derive from heterogeneous populations.
    Methods: We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. We searched Medline, Embase, Epistemonikos and the Cochrane Library for studies assessing the use of prokinetic agents on any indication and outcome in adult hospitalised patients. We used a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence.
    Results: We included 102 studies with a total of 8830 patients. Eighty-six studies were clinical trials (84%), and 52 (60%) of these were conducted in the intensive care unit, with feeding intolerance as the main indication. In the non-intensive care setting the indications were wider; most studies assessed use of prokinetic agents before gastroscopy to improve visualisation. The most studied prokinetic agent was metoclopramide (49% of studies) followed by erythromycin (31%). In total 147 outcomes were assessed with only 67% of the included studies assessing patient-centred outcomes, and with gastric emptying as the most frequently reported outcome. Overall, the data provided no firm evidence on the balance between the desirable and undesirable effects of prokinetic agents.
    Conclusions: In this scoping review, we found that the studies addressing prokinetic agents in hospitalised adults had considerable variations in indications, drugs and outcomes assessed, and that the certainty of evidence was judged to be low to very low.
    MeSH term(s) Adult ; Humans ; Erythromycin/therapeutic use ; Erythromycin/pharmacology ; Gastric Emptying ; Intensive Care Units ; Metoclopramide/therapeutic use ; Metoclopramide/pharmacology
    Chemical Substances Erythromycin (63937KV33D) ; Metoclopramide (L4YEB44I46)
    Language English
    Publishing date 2023-03-08
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.14222
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  6. Article ; Online: Proton pump inhibitors for gastrointestinal bleeding prophylaxis in critically ill patients: A systematic review protocol.

    Wang, Ying / Heels-Ansdell, Diane / Ge, Long / Parpia, Sameer / Ibrahim, Quazi / Cook, Deborah / Deane, Adam / Lauzier, Francois / Hammond, Naomi / Møller, Morten H / Krag, Mette / Perner, Anders / Guyatt, Gordon H

    Acta anaesthesiologica Scandinavica

    2024  

    Abstract: Background: Proton pump inhibitors (PPIs) are the most commonly prescribed drugs for preventing upper gastrointestinal bleeding in critically ill patients. However, concerns have arisen about the possible harms of using PPIs, including potentially ... ...

    Abstract Background: Proton pump inhibitors (PPIs) are the most commonly prescribed drugs for preventing upper gastrointestinal bleeding in critically ill patients. However, concerns have arisen about the possible harms of using PPIs, including potentially increased risk of pneumonia, Clostridioides difficile infection, and more seriously, an increased risk of death in the most severely ill patients. Triggered by the REVISE trial, which is a forthcoming large randomized trial comparing pantoprazole to placebo in invasively mechanically ventilated patients, we will conduct this systematic review to evaluate the efficacy and safety of PPIs versus no prophylaxis for critically ill patients.
    Methods: We will systematically search randomized trials that compared gastrointestinal bleeding prophylaxis with PPIs versus placebo or no prophylaxis in adults in the intensive care unit (ICU). Pairs of reviewers will independently screen the literature, and for those eligible trials, extract data and assess risk of bias. We will perform meta-analyses using a random-effects model, and calculate relative risks for dichotomous outcomes and mean differences for continuous outcomes, and the associated 95% confidence intervals. We will conduct subgroup analysis to explore whether the impact of PPIs on mortality differs in more and less severely ill patients. We will assess certainty of evidence using the GRADE approach.
    Discussion: This systematic review will provide the most up-to-date evidence regarding the merits and limitations of stress ulcer prophylaxis with PPIs in critically ill patients in contemporary practice.
    Language English
    Publishing date 2024-04-05
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.14426
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  7. Article ; Online: Predictors of gastrointestinal bleeding in adult ICU patients in the SUP-ICU trial.

    Granholm, Anders / Krag, Mette / Marker, Søren / Alhazzani, Waleed / Perner, Anders / Møller, Morten Hylander

    Acta anaesthesiologica Scandinavica

    2021  Volume 65, Issue 6, Page(s) 792–800

    Abstract: Background: In previous studies of predictors of gastrointestinal (GI) bleeding in the intensive care unit (ICU), most patients received pharmacological stress ulcer prophylaxis (SUP). We aimed to assess associations between potential predictors of ... ...

    Abstract Background: In previous studies of predictors of gastrointestinal (GI) bleeding in the intensive care unit (ICU), most patients received pharmacological stress ulcer prophylaxis (SUP). We aimed to assess associations between potential predictors of clinically important GI bleeding (CIB) and overt GI bleeding in adult ICU patients, while considering the effect and potential interaction with use of SUP.
    Methods: We included 3291 acutely admitted adult ICU patients with risk factors for GI bleeding randomized to SUP (pantoprazole) or placebo in the SUP-ICU trial. We used logistic regression models adjusted for allocation to SUP to estimate associations between 23 potential predictors and CIB (primary outcome) and overt GI bleeding (secondary outcome). Furthermore, we assessed associations between potential predictors and both outcomes in each allocation group and assessed potential interaction with allocation to SUP.
    Results: Increasing SAPS II and SOFA scores, use of circulatory support and renal replacement therapy were associated with increased risk of CIB and overt GI bleeding; chronic lung disease was associated with increased risk of overt GI bleeding. Results for the remaining potential predictors were compatible with both no difference or increased and decreased risks. We found no strong evidence for any interaction between treatment allocation and any potential predictors.
    Conclusion: In adult ICU patients at risk of GI bleeding, severity of illness, use of circulatory support and renal replacement therapy were associated with higher odds of CIB, with no strong evidence of interaction with SUP.
    MeSH term(s) Adult ; Gastrointestinal Hemorrhage/epidemiology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intensive Care Units ; Pantoprazole ; Peptic Ulcer ; Simplified Acute Physiology Score
    Chemical Substances Pantoprazole (D8TST4O562)
    Language English
    Publishing date 2021-03-15
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.13805
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  8. Article ; Online: The effects of pantoprazole vs. placebo on 1-year outcomes, resource use and employment status in ICU patients at risk for gastrointestinal bleeding: a secondary analysis of the SUP-ICU trial.

    Halling, Christine Marie Bækø / Møller, Morten Hylander / Marker, Søren / Krag, Mette / Kjellberg, Jakob / Perner, Anders / Gyrd-Hansen, Dorte

    Intensive care medicine

    2022  Volume 48, Issue 4, Page(s) 426–434

    Abstract: Purpose: Patients in intensive care units (ICUs) are at risk of stress-related gastrointestinal (GI) bleeding and stress ulcer prophylaxis (SUP), including proton pump inhibitors, is widely used in the attempt to prevent this. In this secondary analysis ...

    Abstract Purpose: Patients in intensive care units (ICUs) are at risk of stress-related gastrointestinal (GI) bleeding and stress ulcer prophylaxis (SUP), including proton pump inhibitors, is widely used in the attempt to prevent this. In this secondary analysis of Stress Ulcer Prophylaxis in Intensive Care Unit (SUP-ICU) trial, we assessed 1-year outcomes in the pantoprazole vs. placebo groups.
    Methods: In the SUP-ICU trial, 3298 acutely admitted ICU patients at risk of GI bleeding were randomly allocated, stratified for site, to pantoprazole or placebo. In this secondary analysis, we assessed clinically important GI bleedings in ICU and 1-year mortality, health care resource use (e.g. readmission with GI bleeding, use of home care and general practitioner), health care costs, and employment status for the Danish participants using registry data.
    Results: Among the 2099 Danish participants, 2092 had data in the registries; 1045 allocated to pantoprazole and 1047 to placebo. The number of clinically important GI bleedings in ICU was 1.9 percentage points [95% CI 0.3-3.5] lower in the pantoprazole group vs. the placebo group, but none of the 1-year outcomes differed statistically significantly between groups, including total health care costs (€1954 [- 2992 to 6899]), readmission with GI bleeding (- 0.005 admissions [- 0.016 to 0.005]), 1-year mortality (- 0.013 percentage points [- 0.051 to 0.026]), and employment (- 0.178 weeks [- 0.390 to 0.034]).
    Conclusion: Among ICU patients at risk of GI bleeding, pantoprazole reduced clinically important GI bleeding in ICU, but this did not translate into a reduction in 1-year mortality, health care resource use or improvements in employment status.
    MeSH term(s) Employment ; Gastrointestinal Hemorrhage/drug therapy ; Gastrointestinal Hemorrhage/prevention & control ; Humans ; Intensive Care Units ; Pantoprazole/therapeutic use ; Peptic Ulcer/drug therapy ; Peptic Ulcer/prevention & control ; Proton Pump Inhibitors/therapeutic use
    Chemical Substances Proton Pump Inhibitors ; Pantoprazole (D8TST4O562)
    Language English
    Publishing date 2022-02-05
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-022-06631-2
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  9. Article ; Online: What's new with stress ulcer prophylaxis in the ICU?

    Marker, Søren / Krag, Mette / Møller, Morten Hylander

    Intensive care medicine

    2017  Volume 43, Issue 8, Page(s) 1132–1134

    MeSH term(s) Anti-Ulcer Agents/adverse effects ; Anti-Ulcer Agents/therapeutic use ; Critical Illness ; Histamine H2 Antagonists/adverse effects ; Histamine H2 Antagonists/therapeutic use ; Humans ; Intensive Care Units ; Observational Studies as Topic ; Peptic Ulcer Hemorrhage/etiology ; Peptic Ulcer Hemorrhage/prevention & control ; Practice Guidelines as Topic ; Proton Pump Inhibitors/adverse effects ; Proton Pump Inhibitors/therapeutic use ; Randomized Controlled Trials as Topic ; Risk Factors ; Stomach Ulcer/complications ; Stomach Ulcer/drug therapy ; Stomach Ulcer/prevention & control ; Stress, Physiological
    Chemical Substances Anti-Ulcer Agents ; Histamine H2 Antagonists ; Proton Pump Inhibitors
    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-017-4733-0
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  10. Article ; Online: Associations between enteral nutrition and outcomes in the SUP-ICU trial: Protocol for exploratory post hoc analyses.

    Borthwick, Mark / Granholm, Anders / Marker, Søren / Krag, Mette / Lange, Theis / Wise, Matt P / Bendel, Stepani / Keus, Frederik / Guttormsen, Anne Berit / Schefold, Joerg C / Wetterslev, Jørn / Perner, Anders / Møller, Morten Hylander

    Acta anaesthesiologica Scandinavica

    2023  Volume 67, Issue 4, Page(s) 481–486

    Abstract: Critically ill patients are at risk of gastrointestinal (GI) bleeding. Counter measures to minimise this risk include the use of pharmacological stress ulcer prophylaxis (SUP). The effect of enteral nutrition as SUP on GI bleeding event rates is unknown. ...

    Abstract Critically ill patients are at risk of gastrointestinal (GI) bleeding. Counter measures to minimise this risk include the use of pharmacological stress ulcer prophylaxis (SUP). The effect of enteral nutrition as SUP on GI bleeding event rates is unknown. There are conflicting data describing the effect of co-administration of enteral nutrition with pharmacological SUP, and there is substantial variation in practice. We aim to conduct an exploratory post hoc analysis to evaluate the association of enteral nutrition with clinically important GI bleed rates in ICU patients included in the SUP-ICU trial, and to explore any interactions between enteral nutrition and pharmacologic SUP on patient outcomes. The SUP-ICU trial dataset will be used to assess if enteral nutrition is associated with the outcomes of interest. Extended Cox models will be used considering relevant competing events, including treatment allocation (SUP or placebo) and enteral nutrition as a daily time-varying covariate, with additional adjustment for severity of illness (SAPS II). Results will be presented as adjusted hazard ratios for treatment allocation and enteral nutrition, and for treatment allocation and enteral nutrition considering potential interactions with the other variable, all with 95% confidence intervals and p-values for the tests of interaction. All results will be considered as exploratory only. This post hoc analysis may yield important insights to guide practice and inform the design of future randomised clinical trial investigating the effect of enteral nutrition on GI bleeding.
    MeSH term(s) Humans ; Critical Illness/therapy ; Enteral Nutrition/methods ; Gastrointestinal Hemorrhage/prevention & control ; Intensive Care Units ; Peptic Ulcer/prevention & control ; Stomach Ulcer ; Ulcer
    Language English
    Publishing date 2023-01-25
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.14194
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