Occurrence of ventilator-associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole.
OBJECTIVE
The purpose of the study was to evaluate the effects of sucralfate, ranitidine, and omeprazole use on incidence of ventilatory-associated pneumonia (VAP) and mortality in ventilated pediatric critical care patients.


METHODS
This prospective study was conducted at the pediatric intensive care unit (PICU) between August 2000 and February 2002. A total of 160 patients who needed mechanical ventilation were randomized into 4 groups according to the computer-generated random number table: group (S), (n = 38) received sucralfate suspension 60 mg/kg/d in 4 doses via the nasogastric tube that was flushed with 10 mL of sterile water; group (R), (n = 42) received ranitidine 2 mg/kg/d intravenously in 4 doses; group (O), (n = 38) received omeprazole 1 mg/kg/d intravenously in 2 doses; and group (P), (n = 42) did not receive any medication for stress ulcer prophylaxis. Treatment was begun within 6 hours of PICU admission.


RESULTS
Seventy patients (44%) developed VAP. VAP rate was 42% (16 of 38) in the sucralfate group, 48% (20 of 42) in the ranitidine group, 45% (17 of 38) in the omeprazole group, and 41% (17 of 42) in the nontreated group. Overall mortality rate was 22% (35 of 160); it was 21% (8 of 38) in the sucralfate group, 23% (10 of 42) in the ranitidine group, 21% (8 of 38) in the omeprazole group, and 21% (9 of 42) in the nontreated group. Our results did not show any difference in the incidence of VAP and mortality in mechanically ventilated PICU patients treated with ranitidine, omeprazole, or sucralfate, or nontreated subjects (P =.963, confidence interval [CI] = 0.958-0.968; P =.988, CI = 0.985-0.991, respectively). Nine patients (5.6%) had macroscopic bleeding. There was no statistically significant difference in macroscopic bleeding between groups.


CONCLUSIONS
Our results did not show any difference in the incidence of VAP, macroscopic stress ulcer bleeding, and mortality in the mechanically ventilated PICU patients treated with ranitidine, omeprazole, or sucralfate, or nontreated subjects. None of the treatment regimens increased VAP compared with the nontreated group. Because there is insufficient data about stress ulcer prophylaxis and VAP in the pediatric age group, more studies with larger numbers of patients are needed.
Yildizdas
Dincer
D
Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey. rdy90@hotmail.com
Yapicioglu
Hacer
H
Yilmaz
Hayri Levent
HL
D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D011899:Ranitidine / Q000008:administration & dosage / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects*; D013276:Stomach Ulcer / Q000150:complications / Q000188:drug therapy*; D013392:Sucralfate / Q000008:administration & dosage / Q000627:therapeutic use; D014421:Turkey / Q000453:epidemiology
D000897:Anti-Ulcer Agents; D013392:Sucralfate; D011899:Ranitidine; D009853:Omeprazole