title: Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophylaxis with sucralfate, antacid, and ranitidine.
abstract: OBJECTIVE
  To compare the incidence of nosocomial pneumonia in critically injured patients randomized to one of three stress ulcer prophylaxis regimens.
  
  
  METHODS
  Prospective, randomized clinical trial.
  
  
  METHODS
  Mechanically ventilated patients admitted to the trauma intensive care unit of a Level I trauma center received sucralfate, antacid, or ranitidine.
  
  
  RESULTS
  Two hundred forty-two patients were randomized: sucralfate, n = 80; antacid, n = 82; and ranitidine, n = 80. There was no statistically significant difference in pneumonia rates among the treatment groups (p = 0.875). Pneumonia occurred more frequently in patients with gram-negative retrograde colonization from stomach to trachea (p = 0.02), but this accounted for only 13% of all pneumonias in the study population. The death rate in patients with pneumonia was not statistically different among the three groups. Although 20% developed overt gastrointestinal bleeding, no episode was clinically significant. Mean gastric pH was > 4 in 95% of the study population, including 88% of patients receiving sucralfate. The death rate in the antacid group was significantly higher (p = 0.046) but not because of increased gastrointestinal bleeding or pneumonia.
  
  
  CONCLUSIONS
  Our results show no difference in the incidence of nosocomial pneumonia in mechanically ventilated trauma patients during the first 4 days of stress ulcer prophylaxis with sucralfate, antacid, or ranitidine. There is a trend toward decreased pneumonia in the sucralfate group after study day 4. Even after controlling for injury severity, the mortality rate in the antacid group was significantly higher; the reasons for this are unknown.
authors.affiliation: Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Thomason
authors.forename: E S
authors.initials: ES
authors.lastname: Payseur
authors.forename: A M
authors.initials: AM
authors.lastname: Hakenewerth
authors.forename: H J
authors.initials: HJ
authors.lastname: Norton
authors.forename: B
authors.initials: B
authors.lastname: Mehta
authors.forename: T R
authors.initials: TR
authors.lastname: Reeves
authors.forename: M W
authors.initials: MW
authors.lastname: Moore-Swartz
authors.forename: P I
authors.initials: PI
authors.lastname: Robbins
mesh_terms: D000328:Adult; D000863:Antacids / Q000627:therapeutic use*; D003428:Cross Infection / Q000209:etiology*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D010437:Peptic Ulcer / Q000150:complications* / Q000517:prevention & control*; D011014:Pneumonia / Q000209:etiology*; D011899:Ranitidine / Q000627:therapeutic use*; D012121:Respiration, Artificial; D013392:Sucralfate / Q000627:therapeutic use*; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D000863:Antacids; D005765:Gastrointestinal Agents; D013392:Sucralfate; D011899:Ranitidine