title: Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitors and/or histamine II receptor blockers.
abstract: Ventilator-associated pneumonia (VAP) is a common cause of infectious morbidity and mortality in the intensive care unit (ICU). The type of stress-ulcer prophylaxis (SUP) given to ventilated patients may, in part, be responsible. We observed an increase in VAP as ventilator bundle compliance increased and a decrease in VAP when bundle compliance decreased. We reasoned that SUP which raises gastric pH such as proton-pump inhibitors (PPIs) and histamine II (H2) receptor antagonists as opposed to SUP which does not raise pH such as sucralfate (S) may be responsible and also may alter the causative bacteria.
  
  
  
  This is a single-center retrospective cohort analysis of all intubated, adult surgical patients admitted to the surgical ICU between January and June during the 3-y period 2012-2014. Demographics, APACHE II, Injury Severity Score, VAP occurrence, culprit bacteria, ventilator days, and ICU days were recorded based on the type of SUP given.
  
  
  
  There were 45 instances of VAP in the 504 study patients, 33 in the PPI/H2 group, and 12 in the S group (P < 0.01). VAP per 1000 ventilator days were 10.2 for PPI/H2 and 3.7 for S (P < 0.01). Culprit bacteria were mostly Pseudomonas, gram-negative bacilli, and methicillin-resistant Staphylococcus aureus in PPI/H2 patients (n = 29) compared with oropharyngeal flora in S patients (n = 6; P < 0.001).
  
  
  
  There was a substantial difference in VAP occurrence and in the culprit bacteria between S and PPI/H2 treated patients due perhaps to gastric alkalization.
authors.affiliation: Division of Surgical Critical Care, Department of Surgery, Maine Medical Center (MMC), Tufts University School of Medicine, Portland, Maine. Electronic address: grindg@mmc.org.
authors.forename: Gene A
authors.initials: GA
authors.lastname: Grindlinger
authors.affiliation: Department of Surgery, Surgical Residency Program, Maine Medical Center, Tufts University School of Medicine, Portland, Maine.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Cairo
authors.affiliation: Department of Epidemiology, Maine Medical Center, Portland, Maine.
authors.forename: Carole B
authors.initials: CB
authors.lastname: Duperre
mesh_terms: D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000517:prevention & control*; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013392:Sucralfate / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D013392:Sucralfate
keywords: Histamine II receptor blockade; Proton-pump inhibitors (PPIs); Stress ulcer; Sucralfate; Ventilator bundle; Ventilator-associated pneumonia (VAP)