OCCURRENCE OF NOSOCOMIAL PNEUMONIA IN MECHANICALLY VENTILATED TRAUMA PATIENTS - A COMPARISON OF SUCRALFATE AND RANITIDINE

Objective: To determine if there is a difference in nosocomial pneumon ia frequency rate in mechanically ventilated trauma patients treated w ith sucralfate vs. ranitidine for stress ulcer prophylaxis. Design: Pr ospective, randomized trial. Setting: A 640-bed urban teaching hospita l and trauma center. Patients: Ninety-two mechanically ventilated trau ma patients. Interventions: Thirty-nine patients received sucralfate a nd 44 patients received intravenous ranitidine for stress ulcer prophy laxis; nine patients were excluded from the study for protocol breaks. Measurements and Main Results: The study population was severely inju red and critically ill. The Trauma Score averaged 11.3, the injury Sev erity Score averaged 27.7, and the Acute Physiology and Chronic Health Evaluation (APACHE) score averaged 18.1. There were no significant di fferences in demographics, mechanisms of injury, Trauma Score, Injury Severity Score, APACHE score, length of hospital stay, length of surgi cal intensive care unit stay, or duration of endotracheal intubation b etween the sucralfate and ranitidine groups. Eleven (13.2%) patients d eveloped nosocomial pneumonia: six (15.4%) of 39 patients in the sucra lfate group and five (11.4%) of 44 patients in the ranitidine group; t hese numbers were not significantly different (chi(2) = 0.0226, p =.88 05). There were no episodes of significant upper gastrointestinal blee ding. Six patients died during hospitalization, all secondary to sever e head injury and none with pneumonia. Conclusions: There was no stati stically significant difference in pneumonia rate in mechanically vent ilated trauma patients receiving stress ulcer prophylaxis with sucralf ate vs. ranitidine.