GASTRIC COLONIZATION AND PNEUMONIA IN INTUBATED CRITICALLY ILL PATIENTS RECEIVING STRESS-ULCER PROPHYLAXIS - A RANDOMIZED, CONTROLLED TRIAL

Objective: To study the effects of pharmacologically increasing gastric pH on gastric colonization and the development of pneumonia in intubated critically ill patients. Design: Randomized, controlled trial Setting. Medical ICU in a university hospital. Patients: Thirty-four tracheotomized patients with tetanus. Interventions: Sixteen patients received iv ranitidine to increase gastric pH > 4 (ranitidine group), while 18 patients received no prophylaxis for upper gastrointestinal bleeding (control group). Measurements and Main Results: Mean gastric pH was higher in the ranitidine group (median 4.7, range 3.6 to 6.1) than in the control group (median 2.1, range 1.2 to 4.9; p < .05). Gastric colonization occurred in 15 (94%) of 16 patients who received ranitidine, 2 days (median; range 1 to 5) after intubation; gastric colonization also occurred in all control patients (median 4 days, range 1 to 9; p < .05). Pneumonia occurred in 13 (81%) of 16 patients who received ranitidine, 3 days (median, range 1 to 5) after intubation and in nine (50%) of 18 control patients (p < .01) 5 days after tracheal intubation (median, range 3 to 14; p < .01). Prior gastric colonization by the pathogen that caused pneumonia was demonstrable in nine (56%) of 16 patients who received ranitidine vs. eight (44%) of 18 control patients (p > .05). The risk for developing pneumonia in the ranitidine-treated group was highest in the first 4 days after tracheal intubation. There was no difference in the frequency of upper gastrointestinal hemorrhage in the two groups. Conclusions: Pharmacologically increasing gastric pH increases the risk for developing pneumonia in intubated critically ill patients. The pneumonia occurs earlier than in untreated control patients.