Histamine 2 receptor antagonists vs intravenous proton pump inhibitors in a pediatric intensive care unit: A comparison of gastric pH

PurposeThe aim of this study was to assess gastric pH in critically ill pediatric patients receiving intravenous stress ulcer medication.Materials and MethodsA prospective study was done in 48 patients with a gastric tube in place who were receiving either ranitidine or a proton pump inhibitor and no enteral nutrition. Daily peak and trough gastric pHs were measured.ResultsThe median age was 7 years 5 months (range, 1 month to 19 years), the median weight was 31 kg (range, 3-130 kg), and the median pediatric risk of mortality 2 (PRISM2) score was 12.5 (range, 0-31). All patients were intubated and 8 received dialysis. The average trough pH was 4.4 ± 1.6 in the ranitidine group, 4.9 ± 1.8 in the once daily proton pump inhibitor group, and 5.0 ± 1.2 in the twice daily proton pump inhibitor group (P = .16). The average peak pH was 5.3 ± 1.8 in the ranitidine group, 5.9 ± 1.6 in the once daily proton pump inhibitor group, and 6.0 ± 1.0 in the twice daily proton pump inhibitor group (P = .06). Three (10%) of 28 trough pH measurements in the twice daily proton pump inhibitor group were more acidic than 4 vs 24 (40%) of 60 in the ranitidine group, and 22 (40%) of 56 in the once daily proton pump inhibitor group (P = .02). One (4%) of 27 peak pH measurements in the twice daily proton pump inhibitor group were more acidic than 4 vs 13 (20%) of 61 in the ranitidine group, and 9 (16%) of 56 in the once daily proton pump inhibitor group (P = .12). Three patients (6%; 95% confidence interval, 0.51%-16%) developed upper gastrointestinal bleeding, and 4 patients (8%; 95% confidence interval, 0%-13%) developed ventilator-acquired pneumonia.ConclusionsMany critically ill pediatric patients receiving stress ulcer prophylaxis have a trough or peak gastric pH more acidic than 4.