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


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


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


METHODS
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.


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).


CONCLUSIONS
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.
Ortiz
J E
JE
Department of Critical Care Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
Sottile
F D
FD
Sigel
P
P
Nasraway
S A
SA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002927:Cimetidine / Q000009:adverse effects / Q000627:therapeutic use; D003422:Critical Care; D005260:Female; D005745:Gastric Acidity Determination; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000150:complications / Q000382:microbiology / Q000628:therapy; D013270:Stomach / Q000187:drug effects / Q000382:microbiology*; D013276:Stomach Ulcer / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D013312:Stress, Physiological / Q000150:complications*; D013392:Sucralfate / Q000009:adverse effects / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D013392:Sucralfate; D002927:Cimetidine