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Stress ulcer prophylaxis in patients on ventilator
V Darlong1, T S Jayalakhsmi, H L Kaul
1Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi 110029.
Tropical Gastroenterology : Official Journal of the Digestive Diseases Foundation
|February 26, 2004
Summary
H2-receptor antagonists like ranitidine and sucralfate effectively prevent stress ulcers in ventilated patients. Sucralfate showed lower gastric colonization rates than ranitidine.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Pharmacology
Background:
- Stress ulcers are a common complication in critically ill patients requiring mechanical ventilation.
- Prophylaxis aims to reduce upper gastrointestinal bleeding and associated morbidity.
Purpose of the Study:
- To compare the efficacy of H2-receptor antagonists (ranitidine) and sucralfate for stress ulcer prophylaxis in mechanically ventilated ICU patients.
- To evaluate the impact on upper gastrointestinal bleeding, gastric pH, and microbial colonization.
Main Methods:
- A randomized clinical trial involving 52 critically ill, ventilated patients.
- Three groups: ranitidine (H2-receptor antagonist), sucralfate, and no prophylaxis (control).
- Monitored upper gastrointestinal bleeding, gastric pH, gastric aspirate, and bronchoalveolar lavage (BAL) cultures.
Main Results:
- Upper gastrointestinal bleeding incidence was significantly lower with ranitidine (12.5%) and sucralfate (14.3%) compared to controls (57.1%).
- Ranitidine increased gastric pH more than sucralfate, but sucralfate resulted in significantly lower gram-negative gastric colonization (33.3%) versus ranitidine (75%).
- BAL culture results were similar across all groups.
Conclusions:
- Both ranitidine and sucralfate are effective in preventing stress-related upper gastrointestinal hemorrhage in ventilated patients.
- Sucralfate may be preferred due to a lower incidence of gastric colonization by gram-negative organisms.
- Further research could explore optimal prophylaxis strategies balancing efficacy and microbial risk.