Gastric alkalinization does not increase the risk of pneumonia in critically ill patients

Nosocomial pneumonia remains an important determinant of hospital-acquired morbidity and mortality. Although therapy designed to prevent stress-induced gastritis has been effective at relieving upper gastrointestinal (GI) bleeding, the use of agents (histamine-2 receptor antagonists, antacids) that raise gastric pH have also been implicated as increasing the incidence of nosocomial pneumonia. Examination of two recently published meta-analyses investigating the role of gastric pH and nosocomial pneumonia and several individual studies show that raising gastric pH does not increase the incidence of nosocomial pneumonia. Importantly, those clinical trials that purport to show that raising gastric pH increases the incidence of nosocomial pneumonia have not been blinded studies and have failed to control for sites of enteral feeding and volume. Taken together, analysis of several clinical trials finds no compelling evidence for the concept that gastric alkalization increases the evidence of nosocomial pneumonia. Given the methodological flaws incurred in several previous studies, the optimal approach for preventing nosocomial pneumonia while preventing stress gastritis-induced upper (GI) bleeding remains to be identified.