Stress ulcer prophylaxis and risk of developing ventilator-associated pneumonia.

Stress ulcer prophylaxis and risk of developing ventilator-associated pneumonia To the Editor: Acute upper gastrointestinal bleeding has long been recognized as a potential life-threatening complication of stress-induced ulceration in critically ill patients. Stress ulcer prophylaxis (SUP) using pharmacologic agents is considered by many clinicians to be an important care component of patients receiving mechanical ventilation. Pharmacologic agents often used in SUP include antacids, histamine-2-receptor antagonists, proton-pump inhibitor, and sucralfate. These medications can be categorized into 2 groups, the ones that suppress gastric acidity and others that do not alter the gastric pH. Many studies have suggested that higher gastric pH has been associated with gastric bacterial overgrowth, tracheobronchial colonization, and developing pneumonia. The Centers for Disease Control and Prevention (CDC) has recommended that sucralfate be the preferred medication in patients with mechanically assisted ventilation. We conducted a study to assess the frequency of SUP medication and the associated risk of ventilator-associated pneumonia (VAP) in patients admitted to an intensive careunit (ICU). The study, conducted from June 2000 to May 2002, included all patients with mechanical-assisted ventilation in the 14-bed adult medical-surgical ICU of Songklanagarind Hospital, a 750-bed university facility serving as medical school, residency training, and regional referral center for south Thailand. Nosocomial infection surveillance has been conducted continuously in the ICU using the CDC scheme. Medical records and nosocomial infection surveillance data of patients admitted to the ICU were reviewed to identify the date and time of SUP administration, NPO (nothing per oral) status, putative risk factors of VAP, and diagnosis of VAP. The association between SUP and VAP was evaluated by multiple logistic regression analysis using STATA statistical software (STATA Corp, College Station, Tex). Results of the study revealed that among 1077 patients with 6850 ventilator-days, SUP was adminis-