[Prevention of stress ulcer and pneumonia: sucralfate]

Pneumonia in ventilated intensive care patients is one of the most serious nosocomial infections with a frequently fatal outcome. Retrograde colonization of the oropharynx originating from the stomach is a recently described phenomenon associated with increased pH values of gastric fluid. Microaspiration of gastric fluid colonized with great numbers of pathogens can lead to ventilator-associated pneumonia. Since the degree of microbial growth is dependent upon the pH of gastric fluid, pH values of gastric aspirates should not exceed pH 4 if stress ulcer prophylaxis is required. It is now known from several clinical studies that the mean pH values of gastric fluid under sucralfate prophylaxis are considerably lower than under conventional stress ulcer prophylaxis. This is at least partly due to the inherent antibacterial activity of the substance. Finally, the most important result is the markedly reduced frequency of pneumonia in ventilated patients compared with conventional prophylaxis regimens.