RANDOMIZED COMPARISON OF GASTRIC PH CONTROL WITH INTERMITTENT AND CONTINUOUS INTRAVENOUS-INFUSION OF FAMOTIDINE IN ICU PATIENTS

To compare gastric pH control using intravenous famotidine as a primed , continuous infusion versus intermittent infusion. Methods: In a pros pective, double-blind study, 40 ICU patients at risk for stress ulcera tion were randomly assigned to receive either famotidine 20 mg intrave nous bolus followed by 1.67 mg/h infusion or famotidine 20 mg intraven ously every 12 h. Intraluminal gastric pH was recorded at baseline and every 4 h using a glass electrode. Clinical outcome indicators were a lso monitored. Subjects were studied for a minimum of 24 h and a maxim um of 6 days. Continuous variables were analyzed by ANOVA and nominal variables by Fisher's exact test (alpha = 0.05). Results: Nineteen pat ients were randomized to the continuous infusion group, and 21 were ra ndomized to the intermittent group. Using gastric pH greater than 4.0 as an endpoint, the continuous group exhibited better pH control, both in terms of percentage of total measurements (83% versus 63%, p < 0.0 01) and time spent above pH 4.0 (91% versus 76%, p < 0.01). Similar re sults were found at pH greater than 5.0 (78% versus 56% for all measur ements for the continuous and bolus groups, respectively (p < 0.001), and 88% versus 72% for the time spent above pH 5.0 (p < 0.01)). Clinic al outcomes, including evidence for gastrointestinal bleeding and hosp ital mortality, did not differ significantly between groups. Conclusio n: Famotidine infusion at 1.67 mg/h, when preceded by a bolus dose of 20 mg, provides a greater and more sustained increase in gastric pH th an intermittent administration of famotidine 20 mg every 12 h.