A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation

Prophylaxis against stress ulcers has traditionally been recommended for the prevention of upper gastrointestinal bleeding in critically ill patients. 1 – 3 Recent natural-history studies have documented a very low incidence of bleeding, 4 however, suggesting that universal prophylaxis may not be warranted. 5 – 7 Respiratory failure and coagulopathy are the strongest risk factors for clinically important gastrointestinal bleeding. 8 – 11 Randomized trials of prophylaxis against stress ulcers, as compared with no prophylaxis, indicate that histamine H 2 -receptor antagonists and antacids prevent clinically important gastrointestinal bleeding. 12 Observational studies have suggested, however, that a higher gastric pH is associated with gastric microbial growth, 13 tracheobronchial colonization, . . .