title: Gastric colonization as a consequence of stress ulcer prophylaxis: a prospective, randomized trial.
abstract: 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.
authors.affiliation: Department of Critical Care Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Ortiz
authors.forename: F D
authors.initials: FD
authors.lastname: Sottile
authors.forename: P
authors.initials: P
authors.lastname: Sigel
authors.forename: S A
authors.initials: SA
authors.lastname: Nasraway
mesh_terms: 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
chemical_list: D000897:Anti-Ulcer Agents; D013392:Sucralfate; D002927:Cimetidine