NOSOCOMIAL PNEUMONIA IN VENTILATED TRAUMA PATIENTS DURING STRESS-ULCER PROPHYLAXIS WITH SUCRALFATE, ANTACID, AND RANITIDINE

Objective: To compare the incidence of nosocomial pneumonia in critica lly injured patients randomized to one of three stress ulcer prophylax is regimens. Design: Prospective, randomized clinical trial. Methods: Mechanically ventilated patients admitted to the trauma intensive care unit of a Level I trauma center received sucralfate, antacid, or rani tidine.Measurements and Main Results: Two hundred forty-two patients w ere randomized: sucralfate, n = 80; antacid, n = 82; and ranitidine, n = 80, There was no statistically significant difference in pneumonia rates among the treatment groups (p = 0.875). Pneumonia occurred more frequently in patients with gram-negative retrograde colonization from stomach to trachea (p = 0.02), but this accounted for only 13% of all pneumonias in the study population. The death rate In patients with p neumonia was not statistically different among the three groups. Altho ugh 20% developed overt gastrointestinal bleeding, no episode was clin ically significant. Mean gastric pH was >4 in 95% of the study populat ion, including 88% of patients receiving sucralfate. The death rate in the antacid group was significantly higher (p = 0.046) but not becaus e of increased gastrointestinal bleeding or pneumonia. Conclusions: Ou r results show no difference in the incidence of nosocomial pneumonia in mechanically ventilated trauma patients during the first 4 days of stress ulcer prophylaxis with sucralfate, antacid, or ranitidine. Ther e is a trend toward decreased pneumonia in the sucralfate group after study day 4. Even after controlling for injury severity, the mortality rate in the antacid group was significantly higher; the reasons for t his are unknown.