Twenty-Four-Hour Esophageal pH Measurement in Mechanically Ventilated Children : A Prospective Cohort Study
Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies..
OBJECTIVES: To assess the prevalence of gastroesophageal reflux in mechanically ventilated children using 24-hour esophageal pH-metry and its role as a risk factor for ventilator-associated pneumonia.
DESIGN: Prospective cohort study.
SETTING: PICU of a tertiary care hospital from North India.
PATIENTS: Mechanically ventilated children 1-15 years old in PICU from July 2015 to June 2017, excluding those receiving acid suppressants, known cases of gastroesophageal reflux disease, having upper gastrointestinal bleed.
INTERVENTION: Demographic details, baseline investigations, diagnosis, treatment details, and Pediatric Risk of Mortality III score were recorded at enrollment. Gastroesophageal reflux was evaluated using 24-hour esophageal pH-metry. Children were followed up for 7 days or 48 hours after extubation for development of ventilator-associated pneumonia using Centers for Disease Control and Prevention criteria. Pathologic acidic gastroesophageal reflux was defined as fall in esophageal pH less than 4 for more than 4% of total time, whereas pathologic alkaline gastroesophageal reflux as rise in esophageal pH greater than 7 for more than 17% of total time.
MEASUREMENTS AND MAIN RESULTS: Sixty-one children (median [interquartile range], age 73 mo [30-132 mo]; 44 boys [72%]) were enrolled. Median Pediatric Risk of Mortality III score was 10.0 (3-16). Median duration of ventilation was 6 days (3-9 d). Pathologic gastroesophageal reflux (acidic or alkaline) was present in 47 children (77%). Twelve children (19.7%) met criteria for pathologic acidic gastroesophageal reflux, whereas 44 children (72.1%) had pathologic alkaline gastroesophageal reflux; nine children (14.7%) had both pathologic acidic and alkaline gastroesophageal reflux. Of the enrolled children, 17 (27.9 %) developed ventilator-associated pneumonia. No patient had both pathologic acidic gastroesophageal reflux and ventilator-associated pneumonia. Of 17 children who developed ventilator-associated pneumonia, 12 (70.5%) had pathologic alkaline gastroesophageal reflux as compared to 32 children (72.7%) among the 44 children who did not develop ventilator-associated pneumonia (p = 0.87).
CONCLUSIONS: The current study shows high incidence of gastroesophageal reflux on 24-hour esophageal pH-metry in mechanically ventilated children with medical diagnoses. The significance of this finding and its impact on ventilator-associated pneumonia and other ventilator-associated events need to be examined in larger studies.
| Errataetall: |
CommentIn: Pediatr Crit Care Med. 2021 Mar 1;22(3):339-341. - PMID 33657619 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
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| Enthalten in: |
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies - 22(2021), 3 vom: 01. März, Seite e203-e212 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gupta, Priyanka [VerfasserIn] |
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| Anmerkungen: |
Date Completed 21.04.2021 Date Revised 23.08.2023 published: Print CommentIn: Pediatr Crit Care Med. 2021 Mar 1;22(3):339-341. - PMID 33657619 Citation Status MEDLINE |
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| doi: |
10.1097/PCC.0000000000002664 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 245 | 1 | 0 | |a Twenty-Four-Hour Esophageal pH Measurement in Mechanically Ventilated Children |b A Prospective Cohort Study |
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| 500 | |a Date Completed 21.04.2021 | ||
| 500 | |a Date Revised 23.08.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Pediatr Crit Care Med. 2021 Mar 1;22(3):339-341. - PMID 33657619 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. | ||
| 520 | |a OBJECTIVES: To assess the prevalence of gastroesophageal reflux in mechanically ventilated children using 24-hour esophageal pH-metry and its role as a risk factor for ventilator-associated pneumonia | ||
| 520 | |a DESIGN: Prospective cohort study | ||
| 520 | |a SETTING: PICU of a tertiary care hospital from North India | ||
| 520 | |a PATIENTS: Mechanically ventilated children 1-15 years old in PICU from July 2015 to June 2017, excluding those receiving acid suppressants, known cases of gastroesophageal reflux disease, having upper gastrointestinal bleed | ||
| 520 | |a INTERVENTION: Demographic details, baseline investigations, diagnosis, treatment details, and Pediatric Risk of Mortality III score were recorded at enrollment. Gastroesophageal reflux was evaluated using 24-hour esophageal pH-metry. Children were followed up for 7 days or 48 hours after extubation for development of ventilator-associated pneumonia using Centers for Disease Control and Prevention criteria. Pathologic acidic gastroesophageal reflux was defined as fall in esophageal pH less than 4 for more than 4% of total time, whereas pathologic alkaline gastroesophageal reflux as rise in esophageal pH greater than 7 for more than 17% of total time | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: Sixty-one children (median [interquartile range], age 73 mo [30-132 mo]; 44 boys [72%]) were enrolled. Median Pediatric Risk of Mortality III score was 10.0 (3-16). Median duration of ventilation was 6 days (3-9 d). Pathologic gastroesophageal reflux (acidic or alkaline) was present in 47 children (77%). Twelve children (19.7%) met criteria for pathologic acidic gastroesophageal reflux, whereas 44 children (72.1%) had pathologic alkaline gastroesophageal reflux; nine children (14.7%) had both pathologic acidic and alkaline gastroesophageal reflux. Of the enrolled children, 17 (27.9 %) developed ventilator-associated pneumonia. No patient had both pathologic acidic gastroesophageal reflux and ventilator-associated pneumonia. Of 17 children who developed ventilator-associated pneumonia, 12 (70.5%) had pathologic alkaline gastroesophageal reflux as compared to 32 children (72.7%) among the 44 children who did not develop ventilator-associated pneumonia (p = 0.87) | ||
| 520 | |a CONCLUSIONS: The current study shows high incidence of gastroesophageal reflux on 24-hour esophageal pH-metry in mechanically ventilated children with medical diagnoses. The significance of this finding and its impact on ventilator-associated pneumonia and other ventilator-associated events need to be examined in larger studies | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Kumar, B Kiran |e verfasserin |4 aut | |
| 700 | 1 | |a Jat, Kana Ram |e verfasserin |4 aut | |
| 700 | 1 | |a Mukherjee, Aparna |e verfasserin |4 aut | |
| 700 | 1 | |a Kapil, Arti |e verfasserin |4 aut | |
| 700 | 1 | |a Kabra, Sushil K |e verfasserin |4 aut | |
| 700 | 1 | |a Lodha, Rakesh |e verfasserin |4 aut | |
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