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Crit Care Med. 1991 Dec;19(12):1491-6.

A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate- or ranitidine-treated intensive care unit patients.

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1
Department of Anaesthesia, Manchester Royal Infirmary, UK.

Abstract

OBJECTIVE:

To compare the frequency of acute stress ulceration and secondary pneumonia caused by aerobic Gram-negative bacilli in ICU patients treated with either sucralfate or ranitidine.

DESIGN:

Prospective, randomized study.

SETTING:

ICU, university hospital.

PATIENTS:

Sixty adult patients who were mechanically ventilated and at risk of developing stress ulceration.

INTERVENTION:

The patients were randomized to receive either sucralfate (1 g every 6 hrs) via the nasogastric tube or iv ranitidine (50 mg every 6 hrs). If the gastric pH was less than 3.5 in the latter group, 30 mL of 0.3M sodium citrate was given via the nasogastric tube.

MEASUREMENTS AND MAIN RESULTS:

On admission, the frequency rate of erosion/ulceration (assessed with the endoscope) was 13.5%. After 4 days, this rate had increased to 18% in sucralfate-treated patients and 36% in ranitidine-treated patients (NS). Mean gastric pH was more alkaline in the ranitidine-treated patients (5.50) compared with the sucralfate-treated patients (4.26) (p less than .01). This pH permitted a higher occurrence rate of gastric colonization by aerobic Gram-negative bacilli in ranitidine-treated patients (64.3%) compared with sucralfate-treated patients (23.8%) (p less than .01). Retrograde bacterial colonization from the stomach to oropharynx and trachea occurred more frequently in ranitidine-treated patients compared with sucralfate-treated patients. Ultimately, the occurrence rate of pneumonia was greater in the ranitidine-treated (35.7%) than in the sucralfate-treated patients (10.3%) (p less than .05).

CONCLUSION:

Based on our findings, we recommend the adoption of sucralfate for routine prophylaxis against stress ulceration.

PMID:
1959368
[Indexed for MEDLINE]
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