Guy Prod'hom, MD; Philippe Leuenberger, MD; Jacques Koerfer, MD; Andre Blum, MD; Rene Chiolero, MD; Marie-Denise Schaller, MD; Claude Perret, MD; Olivier Spinnler, MD; Jacques Blondel, MD; Hans Siegrist, MD; Laylee Saghafi, MPH; Dominique Blanc, PhD; Patrick Francioli, MD
To assess three anti-stress ulcer prophylaxis regimens in mechanically ventilated patients for bacterial colonization, early- and late-onset nosocomial pneumonia, and gastrointestinal bleeding.
Randomized controlled trial.
Consecutive eligible patients with mechanical ventilation and a nasogastric tube. Of 258 eligible patients, 244 were assessable.
Medical and surgical intensive care units.
At intubation, patients were randomly assigned to receive one of the following: antacid (a suspension of aluminum hydroxide and magnesium hydroxide), 20 mL every 2 hours; ranitidine, 150 mg as a continuous intravenous infusion; or sucralfate, 1 g every 4 hours.
Using predetermined criteria, the incidence of gastric bleeding, gastric colonization, early-onset pneumonia, and late-onset pneumonia was assessed in patients intubated for more than 24 hours.
Of 244 assessable patients, macroscopic gastric bleeding was observed in 10%, 4%, and 6% of patients assigned to receive sucralfate, antacid, and ranitidine, respectively (P > 0.2). The incidence of early-onset pneumonia was not statistically different among the three treatment groups (P > 0.2). Among the 213 patients observed for more than 4 days, late-onset pneumonia was observed in 5% of the patients who received sucralfate compared with 16% and 21% of the patients who received antacid or ranitidine, respectively (P = 0.022). Mortality was not statistically different among the three treatment groups. Patients who received sucralfate had a lower median gastric pH (P < 0.001) and less frequent gastric colonization compared with the other groups (P = 0.015). Using molecular typing, 84% of the patients with late-onset gram-negative bacillary pneumonia were found to have gastric colonization with the same bacteria before pneumonia developed.
Stress ulcer prophylaxis with sucralfate reduces the risk for late-onset pneumonia in ventilated patients compared with antacid or ranitidine.
Prod'hom G, Leuenberger P, Koerfer J, Blum A, Chiolero R, Schaller M, et al. Nosocomial Pneumonia in Mechanically Ventilated Patients Receiving Antacid, Ranitidine, or Sucralfate as Prophylaxis for Stress Ulcer: A Randomized Controlled Trial. Ann Intern Med. ;120:653–662. doi: 10.7326/0003-4819-120-8-199404150-00005
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Published: Ann Intern Med. 1994;120(8):653-662.
Gastroenterology/Hepatology, Infectious Disease, Mechanical Ventilation, Peptic Disease, Peptic Ulcer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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