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Pharmacotherapy. 1998 May-Jun;18(3):486-91.

Gastric colonization as a consequence of stress ulcer prophylaxis: a prospective, randomized trial.

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  • 1Department of Critical Care Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.

Abstract

STUDY OBJECTIVE:

To evaluate gastric alkalization and bacterial colonization in critically ill patients receiving stress ulcer prophylaxis with gastric tube feeds, sucralfate, intermittent intravenous cimetidine, or continuous intravenous cimetidine. DESIGN; Prospective, randomized, unblinded trial.

SETTING:

Medical and surgical intensive care units of a large university-affiliated, tertiary care community hospital.

PATIENTS:

Fifty-three evaluable critically ill patients with respiratory failure requiring mechanical ventilation.

INTERVENTIONS:

Patients not receiving nasogastric tube feeds were randomized to sucralfate 1 g every 6 hours, cimetidine 300 mg by intravenous bolus every 8 hours, or cimetidine 900 mg by continuous intravenous infusion/24 hours. Gastric samples were obtained daily for pH and culture.

MEASUREMENTS AND MAIN RESULTS:

Patients with respiratory failure and a high mortality rate had a mean gastric pH of 1.96 +/- 1.5 at study entry. There were no significant differences in gastric pH or gastric colonization among the three arms. Fourteen patients (26%) developed gastric colonization, which was statistically significant but poorly correlated with gastric alkalinity (r2=0.08, p<0.043).

CONCLUSION:

Gastric luminal pH was unchanged regardless of which method was used for stress ulcer prophylaxis. Bacterial colonization was increasingly likely in patients with a persistent alkaline gastric environment.

PMID:
9620099
[PubMed - indexed for MEDLINE]
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