Failure of nasogastric omeprazole suspension in pediatric intensive care patients.
OBJECTIVE
To determine the efficacy of nasogastric administration of omeprazole suspension in raising the gastric pH >4 in critically ill pediatric patients and to determine the most appropriate dosing regimen for this indication.


METHODS
Open-label pharmacodynamic study.


METHODS
Twenty-six bed tertiary-care pediatric intensive care unit.


METHODS
Mechanically ventilated children aged 1-18 yrs with an additional risk factor for stress ulcer formation.


METHODS
Continuous gastric pH monitoring was performed during administration and dose titration of omeprazole suspension to achieve the goal of gastric pH >4 for greater than 75% of the dosing interval.


RESULTS
Data were collected from 18 patients. Subjects were categorized based on the pharmacologic response to nasogastric administration of 1 mg/kg omeprazole suspension (maximum 20 mg) as rapid (n = 9), late (n = 5), and nonresponders (n = 4). Rapid responders required 0.72 mg/kg per day omeprazole suspension to achieve adequate gastric pH elevation for stress ulcer prophylaxis. Late responders required 1.58 mg/kg per day. Nonresponders did not achieve adequate elevation of gastric pH for stress ulcer prophylaxis.


CONCLUSIONS
Nasogastric administration of omeprazole suspension has variable efficacy in critically ill pediatric patients. Half of the studied subjects either required significant dose titrations to achieve gastric acid suppression or did not respond to nasogastric administration of omeprazole suspension.
Haizlip
Julie A
JA
Department of Pediatrics, University of Virginia Children's Medical Center, Charlottesville, USA.
Lugo
Ralph A
RA
Cash
Jared J
JJ
Vernon
Donald D
DD
D000281:Administration, Intranasal; D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005745:Gastric Acidity Determination; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D007223:Infant; D007441:Intubation, Gastrointestinal; D008297:Male; D009853:Omeprazole / Q000008:administration & dosage*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000503:physiopathology* / Q000628:therapy; D013270:Stomach / Q000187:drug effects* / Q000503:physiopathology*; D017211:Treatment Failure
D000897:Anti-Ulcer Agents; D009853:Omeprazole