Randomized, prospective trial of @entity4444 and XXXX for control of intragastric pH in the critically ill.

@entity1 @entity4444 @entity1066 @entity5616 @entity356
Forty-eight critically ill @entity1 in an intensive care unit were enrolled in a prospective study of stress @entity1066 . The H2-receptor antagonists @entity4444 and @entity5616 were used, @entity1 being randomized on hospital number. Response was assessed by measuring gastric pH every 2 hours. The drugs were administered by intravenous infusion, and up to three dosage increments fo each of the drugs were titrated against the pH of the @entity356 . If one drug, in maximum dose, failed to maintain the pH above 4, the other drug was administered at maximum dose. If both drugs failed to achieve control of gastric pH, antacids were administered in an endeavor to ensure @entity1 safety. @entity4444 was successful in maintaining the intragastric pH above 4, for the duration of the intensive care admission, in five of 28 @entity1 . @entity5616 was successful in 10 of 20 @entity1 . The difference between these two groups was statistically significant (p = 0.04). In @entity1 in whom @entity4444 therapy failed, @entity5616 provided adequate control of pH in four of 13. @entity4444 controlled one of six @entity1 who had failed to improve with @entity5616 therapy. Plasma concentrations of both drugs were well above established acid inhibitory concentrations. However, even with much lower plasma concentrations of @entity5616 , similar amounts of both drugs were present in the gastric juice, suggesting a possible explanation for the greater efficacy of @entity5616 . We conclude that, although @entity5616 is more effective than @entity4444 , neither of these drugs is adequate for stress @entity1066 . If they ae used for this purpose in the critically ill @entity1 , regular monitoring of gastric pH is essential to allow detection of therapeutic failures.
