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Gastric Colonization as a Consequence of Stress Ulcer Prophylaxis: A Prospective, Randomized Trial
Author(s) -
Ortiz Jorge E.,
Sottile Frank D.,
Sigel Pamela,
Nasraway Stanley A.
Publication year - 1998
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1998.tb03111.x
Subject(s) - sucralfate , medicine , cimetidine , stress ulcer , mechanical ventilation , randomized controlled trial , intensive care , antacid , bolus (digestion) , prospective cohort study , anesthesia , gastroenterology , surgery , intensive care medicine
Study Objective . To evaluate gastric alkalization and bacterial colonization in critically ill patients receiving stress ulcer prophylaxis with gastric tube feeds, sucralfate, intermittent intravenous cimetidine, or continuous intravenous cimetidine. Design . Prospective, randomized, unblinded trial. Setting . Medical and surgical intensive care units of a large university‐affiliated, tertiary care community hospital. Patients . Fifty‐three evaluable critically ill patients with respiratory failure requiring mechanical ventilation. Interventions . Patients not receiving nasogastric tube feeds were randomized to sucralfate 1 g every 6 hours, cimetidine 300 mg by intravenous bolus every 8 hours, or cimetidine 900 mg by continuous intravenous infusion/24 hours. Gastric samples were obtained daily for pH and culture. Measurements and Main Results . Patients with respiratory failure and a high mortality rate had a mean gastric pH of 1.96 ± 1.5 at study entry. There were no significant differences in gastric pH or gastric colonization among the three arms. Fourteen patients (26%) developed gastric colonization, which was statistically significant but poorly correlated with gastric alkalinity (r 2 =0.08, p<0.043). Conclusion . Gastric luminal pH was unchanged regardless of which method was used for stress ulcer prophylaxis. Bacterial colonization was increasingly likely in patients with a persistent alkaline gastric environment.