COMPARISON OF ACID NEUTRALIZING AND NONACID NEUTRALIZING STRESS-ULCERPROPHYLAXIS IN THERMALLY INJURED PATIENTS

We have compared the effectiveness of non-acid neutralizing stress ulc er prophylaxis (SUC) with sucralfate (n = 48) with that of acid neutra lizing prophylaxis (AN) utilizing antacids and cimetidine (n = 48) in the prevention of stress ulcer bleeding and nosocomial pneumonia (PN) in thermally injured patients. In the subset of intubated patients, th e incidence of PN was 17.8% and 42.8% in the AN and SUC groups, respec tively(p < 0.05) despite a similar postburn time of onset of pneumonia . Ten patients in each group died. Three patients in the SUC group dev eloped upper GI bleeding with one requiring gastrectomy. Bacterial col onization of the upper airway occurred in virtually all patients, wher eas 83% (SUC) and 96% (AN) had colonization of gastric contents. Gram- negative colonization rates for the upper airway were not different (7 0%) whereas 48% of SUC patients compared with 60% of AN patients had g ram-negative gastric colonization. In conclusion, SUC therapy was effi cacious in the prevention of stress ulcer bleeding but did not alter t he rate of bacterial colonization of the airway or gastric contents, a nd was associated with a higher incidence of nosocomial pneumonia in i ntubated patients.