Pneumonia and stress ulceration in severely injured patients. A prospective evaluation of the effects of stress ulcer prophylaxis
T. C. Fabian, B. A. Boucher, M. A. Croce, D. A. Kuhl, S. W. Janning, B. C. Coffey and K. A. Kudsk
Department of Surgery, University of Tennessee, Memphis.
Stress ulcer prophylaxis is a routine aspect of the care of critically
injured patients. Recent reports have suggested that patients undergoing
prophylaxis with histamine antagonists are predisposed to nosocomial
pneumonia, and that treatment with sucralfate can prevent this problem. An
open, prospective randomized trial of three regimens was conducted with 278
evaluable patients. The patients were assigned to one of three group: the
group receiving sucralfate, the group receiving a cimetidine hydrochloride
bolus, and the group undergoing continuous infusion with cimetidine. Stress
ulceration developed in 8% of patients in the sucralfate group, 13% of
patients in the cimetidine bolus group, and 12% of patients in the
cimetidine infusion group, while nosocomial pneumonia developed in 29% of
patients in the sucralfate group, 32% of patients in the cimetidine bolus
group, and 23% of patients in the cimetidine infusion group. Multivariate
analysis of risk factors associated with pneumonia demonstrated independent
significance for score on the Glasgow Coma Scale, Injury Severity Score,
cord injury, shock, and head injury. Only spinal cord injury was associated
with stress ulceration. We conclude that sucralfate and cimetidine are both
effective for stress ulcer prophylaxis and that there is no association of
cimetidine with nosocomial pneumonia.
