Introduction Patients in the pediatric intensive care unit (PICU) are at risk of developing stress ulcers. Achieving a gastric pH of greater than 4 is considered to be protective against ulcer formation. There are many different agents available for ulcer prophylaxis, but based on existing literature, it is unclear which agent is best in pediatric patients.
Objective To compare peak and trough gastric pHs in PICU patients on either histamine receptor antagonists or proton pump inhibitors for ulcer prophylaxis.
Methods PICU patients who had a nasogastric or oral-gastric tube, were on either ranitidine or a proton-pump inhibitor once or twice a day and were not being given enteral nutrition were eligible for enrollment. Daily peak and trough gastric pHs were recorded. Data collection concluded 24 hours after enteral feeding was instituted or when the patient's gastric tube was removed.
Results Forty-nine patients were enrolled. The average age was 8 years 2 months (1 wk to 19 yo) and the average weight was 36 kilograms (3-130 kg). All patients were intubated. The average trough pH was 4.4 6 1.6 in the ranitidine group, 4.9 6 1.8 in the once a day proton pump inhibitor group, and 5.0 6 1.2 in the twice a day proton pump inhibitor group (p = .16). The average peak pH was 5.3 6 1.8 in the ranitidine group, 5.9 6 1.6 in the once a day proton pump inhibitor group and 6.0 6 1.0 in the twice a day proton pump inhibitor group (p = .06). Forty percent (24/60) of trough pH measurements in ranitidine group were less than or equal to 4.0 versus 40% (22/56) in the once a day proton pump inhibitor group and 10% (3/28) in the twice a day proton pump inhibitor group (p = .02). Twenty percent (13/61) of peak pH measurements in the ranitidine group were less than or equal to 4.0 versus 16% (9/56) in the once a day proton pump inhibitor group and 4 (1/27) in the twice a day proton pump inhibitor group (p = .12).
Conclusions There are many pediatric critical care patients on stress ulcer prophylaxis at recommended doses that have a trough and peak pH that is not greater than 4.0. Twice a day proton pump inhibitor therapy should be considered in high-risk patients, as well as direct measurement of gastric pH.
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