Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial

Détails

ID Serval
serval:BIB_78092B78E72C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial
Périodique
Annals of Internal Medicine
Auteur(s)
Prod'hom  G., Leuenberger  P., Koerfer  J., Blum  A., Chiolero  R., Schaller  M. D., Perret  C., Spinnler  O., Blondel  J., Siegrist  H., Saghafi  L., Blanc  D., Francioli  P.
ISSN
0003-4819
Statut éditorial
Publié
Date de publication
04/1994
Peer-reviewed
Oui
Volume
120
Numéro
8
Pages
653-62
Notes
Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't --- Old month value: Apr 15
Résumé
OBJECTIVE: To assess three anti-stress ulcer prophylaxis regimens in mechanically ventilated patients for bacterial colonization, early- and late-onset nosocomial pneumonia, and gastrointestinal bleeding. DESIGN: Randomized controlled trial. PATIENTS: Consecutive eligible patients with mechanical ventilation and a nasogastric tube. Of 258 eligible patients, 244 were assessable. SETTING: Medical and surgical intensive care units. INTERVENTION: At intubation, patients were randomly assigned to receive one of the following: antacid (a suspension of aluminum hydroxide and magnesium hydroxide), 20 mL every 2 hours; ranitidine, 150 mg as a continuous intravenous infusion; or sucralfate, 1 g every 4 hours. MEASUREMENTS: Using predetermined criteria, the incidence of gastric bleeding, gastric colonization, early-onset pneumonia, and late-onset pneumonia was assessed in patients intubated for more than 24 hours. RESULTS: Of 244 assessable patients, macroscopic gastric bleeding was observed in 10%, 4%, and 6% of patients assigned to receive sucralfate, antacid, and ranitidine, respectively (P > 0.2). The incidence of early-onset pneumonia was not statistically different among the three treatment groups (P > 0.2). Among the 213 patients observed for more than 4 days, late-onset pneumonia was observed in 5% of the patients who received sucralfate compared with 16% and 21% of the patients who received antacid or ranitidine, respectively (P = 0.022). Mortality was not statistically different among the three treatment groups. Patients who received sucralfate had a lower median gastric pH (P < 0.001) and less frequent gastric colonization compared with the other groups (P = 0.015). Using molecular typing, 84% of the patients with late-onset gram-negative bacillary pneumonia were found to have gastric colonization with the same bacteria before pneumonia developed. CONCLUSION: Stress ulcer prophylaxis with sucralfate reduces the risk for late-onset pneumonia in ventilated patients compared with antacid or ranitidine.
Mots-clé
Adult Aged Antacids/*therapeutic use Cross Infection/*etiology/mortality Equipment Contamination Female Gastric Acidity Determination Hospital Mortality Humans Male Middle Aged Peptic Ulcer Hemorrhage/etiology/mortality Pneumonia/*etiology/mortality Ranitidine/*therapeutic use Respiration, Artificial/*adverse effects Stress/complications Sucralfate/*therapeutic use Time Factors Ulcer/etiology/*prevention & control
Pubmed
Web of science
Création de la notice
29/01/2008 16:20
Dernière modification de la notice
03/03/2018 18:28
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