Cimetidine for the prophylaxis of potential gastric acid aspiration pneumonitis in trauma patients.

Acute trauma victims are at high risk for gastric aspiration during urgent anesthesia. The morbidity of this complication is well known and is directly related to the acidity of the gastric contents. A pH less than 2.5 is associated with a marked increase in pulmonary sequelae. Cimetidine has been effective in the treatment of peptic ulcer disease because of its ability to elevate gastric pH. This was a prospective randomized study of administering a single dose of cimetidine (300 mg IV) to trauma patients in the Emergency Department. Fifty patients were studied and 39 (78%) had an initial gastric aspirate pH less than 2.5. The gastric pH remained in this critical range over the ensuing 4 hours in 19 (90%) of the 21 patients not receiving cimetidine. In contrast, only two (11%) of the 18 patients given cimetidine were observed to have gastric pH levels less than 3.0, 1 hour after administration. This protective effect was maintained over the subsequent 3 hours of observation. These preliminary findings warrant further clinical trial of cimetidine for the prophylaxis against aspiration pneumonitis in patients at high risk for this complication.

RCT Entities:   Population Interventions Outcomes