Comparative study of the effect of Rantidine and Pantoprazole on Incidence of Ventilator-Associated Pneumonia

Abstract

Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs 48-72 hours or thereafter following endotracheal intubation. VAP contributes to approximately half of all cases of hospital-acquired pneumonia. VAP is estimated to occur in 9-27 % of all mechanically ventilated patients, with the highest risk being early in the course of hospitalization. Inhalation, aspiration, and hematogenous spread are the three main mechanisms by which bacteria reach the lungs. Aspiration pneumonia is due to the aspiration of colonized upper respiratory tract secretions. The stomach appears to be an important reservoir for gram-negative bacilli that can ascend and colonize the respiratory tract. Acid-suppressive medications such as proton pump inhibitors and histamine type 2 (H2) receptor antagonists are used to prevent stress ulcers. Theoretically, the inhibition of gastric acid secretion can be associated with increased gastric colonization as well as retrograde colonization of the pharynx leading to VAP with potential micro-aspiration. The aim of this work was to compare the effects of ranitidine and pantoprazole on incidence of Ventilator Associated Pneumonia (VAP). The current study was a prospective observational, double-blind study conducted on 124 patients older than 18 years who were intubated after admission to the Critical Care Medicine Departments in Ain Shams University Hospitals. Patients in the study were equally randomized into two groups. Group I (ranitidine): patients received ranitidine for stress ulcer prophylaxis. Group II (pantoprazole): patients received pantoprazole for stress ulcer prophylaxis. Exclusion criteria included: • Patients with pneumonia on ICU admission. • Patients with gastrointestinal bleeding on admission. • Patients with history of gastrectomy. • Patients with anticipated need for mechanically