Control and variability of gastric pH in critically ill children

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Abstract

Design:

Prospective, descriptive study.

Setting:

Pediatric ICU of a children's hospital.

Patients:

Fourteen pediatric ICU patients.

Interventions:

Ranitidine (4 mg/kg/day) was administered to all patients.

Measurements and Main Results:

Patients enrolled in the study were divided into two groups based on illness type and severity. Illness severity was measured by the Pediatric Risk of Mortality (PRISM) score, with a PRISM score of >20 defining severe illness. Illness type was designated as central nervous system or noncentral nervous system. Gastric pH was continuously monitored in all patients using an intragastric, pH-sensitive electrode. Poor control of gastric pH was defined as a pH of <4.0 for >20% of the time monitored. The statistical significance of the differences between groups was measured using the Wilcoxon two-sample test or Fisher's exact test. Patients with severe illness or acute central nervous system injury had a lower mean gastric pH than all other patients (4.6 vs. 6.4;p = .008) and spent more time with a gastric pH of <4.0 than other patients (47.5% of time monitored vs. 12.5% of time monitored; p = .003). Poor control of gastric pH occurred in 100% of patients with severe illness or acute central nervous system injury, while only 20% of the remaining patients had poor control of gastric pH (p = .01). Using power-spectrum analysis to evaluate gastric pH variability, gastric pH in patients receiving bolus ranitidine was more variable than gastric pH in patients receiving ranitidine continuously (p = .045). Illness severity or type had no effect on gastric pH variability (p = .78).

Conclusions:

a) Continuous infusion of ranitidine decreases variability of gastric pH in pediatric ICU patients; b) gastric pH variability may make intermittent monitoring of gastric pH inaccurate; c) children with acute central nervous system injury or PRISM scores of ≥20 have poor control of gastric pH; d) type of injury and PRISM scores predict response to ranitidine therapy. (Crit Care Med 1993; 21:1850–1855)

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