1028 Gastroesophageal Reflux in Critically Ill Children

Introduction: Gastroesophageal reflux (GER) is common in children, but its incidence in critically ill pediatric patients is unknown. Our objective was to study the incidence and type of GER in critically ill children. Methods: Prospective observational study in critically ill children aged 1 month to 14 years. A multichannel catheter (MII) was inserted at the admittance in the PICU. This catheter has 6 channels for esophageal multichannel intraluminal impedance (MII) and 2 channels for esophageal and gastric pH measurement. Patients were studied during 48 hours. Results: Twenty-four patients (mean age, 16.4 months) were studied. MII detected the presence of GER in 80% of patients, whereas pH monitoring only detected 20%, although the correlation between the two was good. MII detected 320 episodes of GER (58% acid, 42% alkaline; 143 were gas type) whereas pH monitoring detected 26 episodes (100% acid). Patients with most episodes of GER were children between 7 and 12 months. The median duration of the longest episodes of GER was 4.1 minutes by pH monitoring and 2.3 minutes by MII. There was no relationship between the PRISM or PIM scores and the number of episodes of GER. There were no differences in the number or types of reflux according to the administration of epinephrine, dopamine, midazolam, fentanyl, or vecuronium. Conclusions: The incidence of GER in critically ill children is high. MII is more sensitive than pH monitoring because many GER episodes are alkaline or weak acid.