The comparison between proton pump inhibitors and sucralfate in incidence of ventilator associated pneumonia in critically ill patients

Khorvash, Farzin; Abbasi, Saeed; Meidani, Mohsen; Dehdashti, Fatemeh; Ataei, Behrooz

The comparison between proton pump inhibitors and sucralfate in incidence of ventilator associated pneumonia in critically ill patients

Authors

¹ Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran

³ Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Ventilator associated pneumonia (VAP) are one of the most common nosocomial infections in intensive care unit (ICU). The ICU patients are at risk of stress ulcer and gastrointestinal bleeding for different reasons. In order to prevent this complication, anti acids are used for patients. This study compared pantoprazole with sucralfate in incidence of ventilator associated pneumonia.
Materials and Methods: This randomized clinical trial was carried out on ICU patients with mechanical ventilation in Alzahra university hospital in Isfahan from 2010 to 2011. One hundred forty eight ventilated patients were randomly allocated in two groups. The first group was treated with sucralfate and the second group was treated with pantoprazole for stress ulcer prophylaxis and followed up during hospitalization in ICU for nosocomial pneumonia. Data analyzed by SPSS software.
Results: One hundred thirty seven patients were selected for study. During the study period, 34 cases (24.8%) acquired pneumonia, of which 10 were in the sucralfate group and 24 were in the pantoprazole group (14.1% vs. 36.4%). According to Chi-square test, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group ( P < 0.001).
Conclusion: On the basis of the results, there is a significant relationship between the kind of drug used for stress ulcer and ventilator associated pneumonia. According to this article, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group.

Keywords

References

1.	Ghiasvandian MS. Nosocomial infection in the intensive care unit. Hayat 2002;8:27-34.
2.	Koenig SM, Truwit JD. Ventilator-associated pneumonia: Diagnosis, treatment, and prevention. Clin Microbiol Rev 2006;19:637-57. [PUBMED]
3.	Abele-Horn M, Dauber A, Bauernfeind A, Russwurm W, Seyfarth-Metzqer I, Gleich P, et al. Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD). Intensive Care Med 1997;23:187-95.
4.	Doschner I. Stress ulcer prophylaxis and ventilation peunmonia. Available from: http://www.JSTOR.org/pss .
5.	Zandyeh M, Falhgari G, Salavsti M, Borzoo S. Study of applying proposed infection control standards in ICU. J Shahr-e-Kord Univ Med Sci 2005;6:79-86.
6.	Fabian TC, Boucher BA, Croce MA, Kuhl DA, Janning SW, Coffey BC, et al. Pneumonia and stress ulceration in severely injured patients. A prospective evaluation of the effects of stress ulcer prophylaxis. Arch Surg 1993;128:185-91. [PUBMED]
7.	Ryan P, Dawson J, Teres D, Celoria G, Navab F. Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate. Arch Surg 1993;128:1353-7. [PUBMED]
8.	Quenot JP, Thiery N, Barbar S. When should stress ulcer prophylaxis be used in the ICU. Available from: http://nananaru.webs.com/med/reviews/ .
9.	Najafi A, Ghaffari SR, Mojtahedzadeh M, Khajavi MR, Haji Mohammadi F, Haji Mohammadi M. Comparison the incidence of aspiration pneumonia in criticaly ill patients recieving sucralfate or ranitidine in Sina hospital in the years of 1382-1383. J Iran Soc Anesthesiol Intensive Care 2005;2:28-36.
10.	Horan TC, Gaynes RP. Surveillance of nosocomial infections. 3 ^rd ed. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 1659-702.
11.	Nezam K, Borjian S, Rahati O. The effect of prophylaxis therapy on prevention from gastrointestinal bleeding in ICU in patients. Zahedan J Res Med Sci 2005;7:9-15.
12.	Miano TA, Reichert MG, Houle TT, Macgregor DA, Kincaid EH, Bowton DL. Nosocomial pneumonia risk and stress ulcer prophylaxis: A comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest 2009;136:440-7. [PUBMED]
13.	David C. Gastrointestinal effects of stress-related mucosal disease: Risk of nosocomial pneumonia. Available from: http://www.medscape.com/viewarticle/ .

Advanced Biomedical Research