Control and variability of gastric pH in critically ill children. Crit Care Med 1993 Dec;21(12):1850-5
Date
12/01/1993Pubmed ID
8252889DOI
10.1097/00003246-199312000-00011Scopus ID
2-s2.0-0027494243 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
OBJECTIVES: To determine the effect of illness severity and acute central nervous system injury on the control and variability of gastric pH in pediatric intensive care unit (ICU) patients receiving ranitidine.
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 > or = 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 > or = 20 have poor control of gastric pH; d) type of injury and PRISM scores predict response to ranitidine therapy.
Author List
Gedeit RG, Weigle CG, Havens PL, Werlin SLAuthor
Rainer G. Gedeit MD Associate Chief Medical Officer in the Children's Administration department at Children's WisconsinMESH terms used to index this publication - Major topics in bold
Central Nervous System DiseasesChild
Child, Preschool
Fourier Analysis
Gastric Acid
Gastric Acidity Determination
Gastrointestinal Hemorrhage
Humans
Hydrogen-Ion Concentration
Infant
Infusions, Intravenous
Injections, Intravenous
Intensive Care Units, Pediatric
Monitoring, Physiologic
Ranitidine
Risk Factors
Severity of Illness Index
