Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitors and/or histamine II receptor blockers

J Surg Res. 2016 Dec;206(2):398-404. doi: 10.1016/j.jss.2016.08.028. Epub 2016 Aug 12.

Abstract

Background: Ventilator-associated pneumonia (VAP) is a common cause of infectious morbidity and mortality in the intensive care unit (ICU). The type of stress-ulcer prophylaxis (SUP) given to ventilated patients may, in part, be responsible. We observed an increase in VAP as ventilator bundle compliance increased and a decrease in VAP when bundle compliance decreased. We reasoned that SUP which raises gastric pH such as proton-pump inhibitors (PPIs) and histamine II (H2) receptor antagonists as opposed to SUP which does not raise pH such as sucralfate (S) may be responsible and also may alter the causative bacteria.

Materials and methods: This is a single-center retrospective cohort analysis of all intubated, adult surgical patients admitted to the surgical ICU between January and June during the 3-y period 2012-2014. Demographics, APACHE II, Injury Severity Score, VAP occurrence, culprit bacteria, ventilator days, and ICU days were recorded based on the type of SUP given.

Results: There were 45 instances of VAP in the 504 study patients, 33 in the PPI/H2 group, and 12 in the S group (P < 0.01). VAP per 1000 ventilator days were 10.2 for PPI/H2 and 3.7 for S (P < 0.01). Culprit bacteria were mostly Pseudomonas, gram-negative bacilli, and methicillin-resistant Staphylococcus aureus in PPI/H2 patients (n = 29) compared with oropharyngeal flora in S patients (n = 6; P < 0.001).

Conclusions: There was a substantial difference in VAP occurrence and in the culprit bacteria between S and PPI/H2 treated patients due perhaps to gastric alkalization.

Keywords: Histamine II receptor blockade; Proton-pump inhibitors (PPIs); Stress ulcer; Sucralfate; Ventilator bundle; Ventilator-associated pneumonia (VAP).

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Anti-Ulcer Agents / adverse effects*
  • Anti-Ulcer Agents / therapeutic use
  • Critical Care / methods*
  • Female
  • Histamine H2 Antagonists / adverse effects*
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer / complications
  • Peptic Ulcer / prevention & control*
  • Pneumonia, Ventilator-Associated / etiology
  • Pneumonia, Ventilator-Associated / microbiology
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Proton Pump Inhibitors / adverse effects*
  • Proton Pump Inhibitors / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Sucralfate / therapeutic use*
  • Treatment Outcome

Substances

  • Anti-Ulcer Agents
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors
  • Sucralfate