Nosocomial Pneumonia in Mechanically Ventilated Patients Receiving Ranitidine or Sucralfate as Stress Ulcer Prophylaxis

Abstract

This study was conducted to evaluate the incidence of early- and late-onset nosocomial pneumonia, gastric colonization, and gastrointestinal bleeding in 50 orotracheally intubated, mechanically ventilated patients treated with sucralfate or ranitidine for stress ulcer prophylaxis in the intensive care unit. Patients received either iv ranitidine (50 mg every 6h) in Ranitidine group or nasogastric sucralfate suspension (1 g every 6h) in Sucralfate group. The overall incidence of pneumonia and incidence of early-onset pneumonia was comparable between the two groups (p > 0.05). Late- onset pneumonia was observed in 10 (23.8%) patients in the Ranitidine group and 2 (4.8%) patients in the Sucralfate group (P= 0.001). The mean gastric pH (6.04 ± 1.34 and 3.64 ± 1.55, respectively; P= 0.001)), rate of gastric colonization (92% and 16%, respectively; P=0.000), and gastric source of pneumonia (10 patients and 1 patient, respectively; P= 0.017) was higher in the Ranitidine group as compared to the Sucralfate group. Mortality and gastrointestinal bleeding were comparable between groups. We concluded that stress ulcer prophylaxis with ranitidine increases the risk for late- onset pneumonia in mechanically ventilated critically ill patients by favoring gastric colonization by gram- negative bacilli compared with sucralfate. In patients receiving mechanical ventilation, the use of sucralfate may be preferable to H 2 blockers.

Keywords

• Nosocomial pneumonia; Stress ulcer; Sucralfate;Ranitidine; Tracheal intubation; Mechanical ventilation