{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:49:38Z","timestamp":1781632178687,"version":"3.54.5"},"reference-count":38,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We systematically searched PubMed, Embase, and Cochrane, and we included articles that evaluated subjects admitted to the ICU using mechanical ventilation for &gt;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\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic. We use Mantel\u2013Haenszel as a statistical test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      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\u2009years. 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\u20131.34,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .77;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 69%) or all-cause mortality (31.88% vs 20.35%; OR 1.30, 95% CI 0.96\u20131.76,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .09;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 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\u20133.98;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .52;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 76%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/respcare.12397","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T04:05:51Z","timestamp":1749182751000},"page":"1159-1167","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Ventilator-Associated Pneumonia in Patients Using Proton Pump Inhibitors Versus Histamine H2 Receptor Antagonists: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"70","author":[{"given":"Francisco Willamy Pedrosa","family":"Alves Filho","sequence":"first","affiliation":[{"name":"Dr. Alves Filho is affiliated with Department of Medicine, Federal University of Cear\u00e1, Sobral, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00e1gila Alves","family":"Lima","sequence":"additional","affiliation":[{"name":"Drs. Lima, Mendes, and Sales are affiliated with Department of Medicine, Christus University Center, Fortaleza, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz Ximenes","family":"Mendes","sequence":"additional","affiliation":[{"name":"Drs. Lima, Mendes, and Sales are affiliated with Department of Medicine, Christus University Center, Fortaleza, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivna Cavalcante Barros","family":"Sales","sequence":"additional","affiliation":[{"name":"Drs. Lima, Mendes, and Sales are affiliated with Department of Medicine, Christus University Center, Fortaleza, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCN.0000431438.84502.a3"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.micinf.2004.12.002"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00582-2017"},{"issue":"2","key":"e_1_3_4_5_2","first-page":"1","article-title":"Prevention of ventilator-associated pneumonia in adults","volume":"24","author":"Prescott HC","year":"2010","unstructured":"Prescott HC, , O\u2019Brien JM. Prevention of ventilator-associated pneumonia in adults. Med Rep, 2010; 24(2):1\u20134.","journal-title":"Med Rep"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-50805-z"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-024-09909-6"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.5492\/wjccm.v5.i1.57"},{"issue":"09","key":"e_1_3_4_9_2","first-page":"1","article-title":"Impact of short-term proton pump inhibitors vs. histamine-2 receptor antagonists on gut microbiota in patients with acute coronary syndrome: A multicenter randomized trial","volume":"23","author":"Chen C","year":"2024","unstructured":"Chen C, , Liang H, , He M, et al. Impact of short-term proton pump inhibitors vs. histamine-2 receptor antagonists on gut microbiota in patients with acute coronary syndrome: A multicenter randomized trial. Chin Med J, 2024; 23(09):1\u201310.","journal-title":"Chin Med J"},{"issue":"2","key":"e_1_3_4_10_2","first-page":"16","article-title":"Effects of ranitidine and pantoprazole on ventilator-associated pneumonia: A randomized double-blind clinical trial","volume":"12","author":"Bashar FR","year":"2013","unstructured":"Bashar FR, , Manuchehrian N, , Mahmoudabadi M, et al. Effects of ranitidine and pantoprazole on ventilator-associated pneumonia: A randomized double-blind clinical trial. Tanaffos, 2013; 12(2):16\u201321; doi: 25191457","journal-title":"Tanaffos"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-019-1105-y"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001562"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/MJT.0000000000001514"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.474"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-2-82"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2632"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.898422"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2016.08.028"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.4103\/iahs.iahs_16_19"},{"issue":"2","key":"e_1_3_4_20_2","first-page":"67","article-title":"Comparison of the effects of ranitidine and pantoprazole on incidence of ventilator-associated pneumonia","volume":"3","author":"Rozmina S","year":"2023","unstructured":"Rozmina S, , Bagheri Moghaddam A, , Sadrzadeh SM, et al. Comparison of the effects of ranitidine and pantoprazole on incidence of ventilator-associated pneumonia. Eurasian J Sci Technol, 2023; 3(2):67\u201372.","journal-title":"Eurasian J Sci Technol"},{"issue":"6","key":"e_1_3_4_21_2","first-page":"501","article-title":"Prediction of ventilator-associated pneumonia in patients undergoing stress ulcer prophylaxis: A longitudinal descriptive study in Iran","volume":"27","author":"Nikpour S","year":"2020","unstructured":"Nikpour S, , Mokhber A, , Hajiesmaeili M, et al. Prediction of ventilator-associated pneumonia in patients undergoing stress ulcer prophylaxis: A longitudinal descriptive study in Iran. J Kerman Univ Med Sci, 2020; 27(6):501\u2013509.","journal-title":"J Kerman Univ Med Sci"},{"issue":"10","key":"e_1_3_4_22_2","first-page":"1","article-title":"Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions (editorial)","volume":"10","author":"Cumpston M","year":"2019","unstructured":"Cumpston M, , Li T, , Page MJ, et al. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions (editorial). Cochrane Database Syst, 2019; 10(10):1\u20132.","journal-title":"Cochrane Database Syst"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aidm.2013.06.001"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2023.100750"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2019.323"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00048507"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.22190"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.89a.21085"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1305-6"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1714919"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mpaic.2011.11.009"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.02.014"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2404245"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05526-z"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2017.03.005"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.4103\/2277-9175.125789"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2008.03.002"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/respcare.12397","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/respcare.12397","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/respcare.12397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T01:36:50Z","timestamp":1777685810000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/respcare.12397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,6]]},"references-count":38,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1089\/respcare.12397"],"URL":"https:\/\/doi.org\/10.1089\/respcare.12397","relation":{},"ISSN":["1943-3654","1943-3654"],"issn-type":[{"value":"1943-3654","type":"print"},{"value":"1943-3654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,6]]}}}