title: A graded combination regimen for maintenance of gastric pH above 3.5 in critically ill patients.
abstract: Prophylaxis of acute upper gastrointestinal bleeding by control of gastric pH has been widely advocated for intensive care patients. H2-blockers and antacids have been used and demonstrated to be incompletely effective at maintaining gastric pH above 4. A study of 100 patients measured the efficacy of two-hourly gastric pH measurement and titrated therapy consisting of five levels: 1. no therapy 2. ranitidine 50 mg 8 hourly intravenously 3. ranitidine plus Mylanta 30 ml 2 hourly by nasogastric tube 4. ranitidine plus Mylanta 60 ml 2 hourly and 5. ranitidine 100 mg 8 hourly intravenously plus Mylanta II 60 ml 2 hourly. The level of treatment required by proportions of the total study group were (1) 15%, (2) 71%, (3) 96%, (4) 100%. Head-injured and intubated patients generally fell in the more resistant group while patients having had major elective surgery required lower levels of therapy. If control of gastric pH is to be uniformly achieved, a technique of titrated therapy based on gastric pH measurements is supported as cheaper and more effective than other standardised treatment regimens.
authors.affiliation: Department of Anaesthesia and Intensive Care, Prince Henry Hospital, Sydney, New South Wales, Australia.
authors.forename: R W
authors.initials: RW
authors.lastname: Morris
authors.forename: M
authors.initials: M
authors.lastname: Boyle
authors.forename: S
authors.initials: S
authors.lastname: Jacobs
authors.forename: T
authors.initials: T
authors.lastname: Torda
mesh_terms: D000328:Adult; D000368:Aged; D000536:Aluminum Hydroxide / Q000008:administration & dosage*; D000863:Antacids / Q000008:administration & dosage*; D003422:Critical Care; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005750:Gastric Juice / Q000187:drug effects*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008276:Magnesium Hydroxide / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011899:Ranitidine / Q000008:administration & dosage*; D012841:Simethicone / Q000008:administration & dosage*
chemical_list: D000863:Antacids; D004338:Drug Combinations; C008570:aluminum hydroxide, magnesium hydroxide, simethicone drug combination; D000536:Aluminum Hydroxide; D012841:Simethicone; D011899:Ranitidine; D008276:Magnesium Hydroxide