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. 1996 Jul;75(1):46–50. doi: 10.1136/adc.75.1.46

Simultaneous tracheal and oesophageal pH monitoring during mechanical ventilation.

V Hue 1, F Leclerc 1, F Gottrand 1, A Martinot 1, V Crunelle 1, Y Riou 1, A Deschildre 1, C Fourier 1, D Turck 1
PMCID: PMC1511655  PMID: 8813870

Abstract

OBJECTIVE: To simultaneously record tracheal and oesophageal pH in mechanically ventilated children to determine: (1) the feasibility and safety of the method; (2) the incidence of gastro-oesophageal reflux (GOR) and pulmonary contamination; and (3) their associated risk factors. DESIGN: Prospective study. SETTING: Paediatric intensive care unit in a university hospital. PATIENTS: Twenty mechanically ventilated children (mean age 6.7 years) who met the following inclusion criteria: endotracheal tube with an internal diameter of 4 mm or more (cuffed or uncuffed), mechanical ventilation for an acute disease, no treatment with antiacids, prokinetics, or H2-receptor blockers, and no nasogastric or orogastric tube. METHODS: The tracheal antimony pH probe was positioned 1 cm below the distal end of the endotracheal tube. The oesophageal antimony pH probe was positioned at the lower third of the oesophagus. pH was recorded on a double channel recorder and analysed with EsopHogram 5.01 software and by examination of the trace. The following definitions were used: GOR index, percentage of time pH < 4; pathological GOR, GOR index > 4.8%; tracheal reflux, fall in tracheal pH < 4, 4.5, or 5, or a decrease of one unit from baseline, in both cases preceded by an episode of GOR. The results were analysed statistically by Fisher's exact and the Kruskal-Wallis test. RESULTS: The procedure was well tolerated and the median duration of analysable recording was 6 hours (range 5-22.6). Pathological GOR was observed in eight (40%) children. GOR was more frequent with an uncuffed endotracheal tube than with a cuffed one (p = 0.01). Tracheal reflux (pH < 4) was observed in four children (20%) without clinical evidence of pulmonary aspiration. Episodes of tracheal reflux were associated with a GOR index > 10% (p < 0.01) and were more frequent with a maximal inspiratory pressure of < 25 cm H2O (p = 0.03), but were not related to the indication for mechanical ventilation, whether the endotracheal tube was cuffed or not, age, or drug treatment. CONCLUSIONS: Simultaneous tracheal and oesophageal pH monitoring was feasible in the setting of this study. Tracheal reflux can occur without pathological GOR, and GOR may occur without tracheal reflux. Further prospective studies in larger groups of patients are now justified.

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Selected References

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  1. Browning D. H., Graves S. A. Incidence of aspiration with endotracheal tubes in children. J Pediatr. 1983 Apr;102(4):582–584. doi: 10.1016/s0022-3476(83)80191-7. [DOI] [PubMed] [Google Scholar]
  2. Colombo J. L., Hallberg T. K. Recurrent aspiration in children: lipid-laden alveolar macrophage quantitation. Pediatr Pulmonol. 1987 Mar-Apr;3(2):86–89. doi: 10.1002/ppul.1950030209. [DOI] [PubMed] [Google Scholar]
  3. Corwin R. W., Irwin R. S. The lipid-laden alveolar macrophage as a marker of aspiration in parenchymal lung disease. Am Rev Respir Dis. 1985 Sep;132(3):576–581. doi: 10.1164/arrd.1985.132.3.576. [DOI] [PubMed] [Google Scholar]
  4. Gastinne H., Canard J. M., Pillegand B., Voultoury J. C., Catanzano A., Claude R., Gay R. Oesophagite au cours de la ventilation artificielle. Nouv Presse Med. 1982 Oct 16;11(41):3029–3032. [PubMed] [Google Scholar]
  5. Gaynor E. B. Gastroesophageal reflux as an etiologic factor in laryngeal complications of intubation. Laryngoscope. 1988 Sep;98(9):972–979. doi: 10.1288/00005537-198809000-00012. [DOI] [PubMed] [Google Scholar]
  6. Goitein K. J., Rein A. J., Gornstein A. Incidence of aspiration in endotracheally intubated infants and children. Crit Care Med. 1984 Jan;12(1):19–21. doi: 10.1097/00003246-198401000-00005. [DOI] [PubMed] [Google Scholar]
  7. Goodwin S. R., Graves S. A., Haberkern C. M. Aspiration in intubated premature infants. Pediatrics. 1985 Jan;75(1):85–88. [PubMed] [Google Scholar]
  8. Gustafsson P. M., Kjellman N. I., Tibbling L. Bronchial asthma and acid reflux into the distal and proximal oesophagus. Arch Dis Child. 1990 Nov;65(11):1255–1258. doi: 10.1136/adc.65.11.1255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hebra A., Hoffman M. A. Gastroesophageal reflux in children. Pediatr Clin North Am. 1993 Dec;40(6):1233–1251. doi: 10.1016/s0031-3955(16)38659-x. [DOI] [PubMed] [Google Scholar]
  10. Hopper A. O., Kwong L. K., Stevenson D. K., Shahin S. M., D'Harlingue A., Tsuboi K. K., Ariagno R. L. Detection of gastric contents in tracheal fluid of infants by lactose assay. J Pediatr. 1983 Mar;102(3):415–418. doi: 10.1016/s0022-3476(83)80668-4. [DOI] [PubMed] [Google Scholar]
  11. Ibáez J., Peñafiel A., Raurich J. M., Marse P., Jordá R., Mata F. Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions. JPEN J Parenter Enteral Nutr. 1992 Sep-Oct;16(5):419–422. doi: 10.1177/0148607192016005419. [DOI] [PubMed] [Google Scholar]
  12. Inglis T. J., Sherratt M. J., Sproat L. J., Gibson J. S., Hawkey P. M. Gastroduodenal dysfunction and bacterial colonisation of the ventilated lung. Lancet. 1993 Apr 10;341(8850):911–913. doi: 10.1016/0140-6736(93)91208-4. [DOI] [PubMed] [Google Scholar]
  13. Jack C. I., Calverley P. M., Donnelly R. J., Tran J., Russell G., Hind C. R., Evans C. C. Simultaneous tracheal and oesophageal pH measurements in asthmatic patients with gastro-oesophageal reflux. Thorax. 1995 Feb;50(2):201–204. doi: 10.1136/thx.50.2.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jack C. I., Walshaw M. J., Tran J., Hind C. R., Evans C. C. Twenty-four-hour tracheal pH monitoring--a simple and non-hazardous investigation. Respir Med. 1994 Jul;88(6):441–444. doi: 10.1016/s0954-6111(05)80047-2. [DOI] [PubMed] [Google Scholar]
  15. Katz P. O. Ambulatory esophageal and hypopharyngeal pH monitoring in patients with hoarseness. Am J Gastroenterol. 1990 Jan;85(1):38–40. [PubMed] [Google Scholar]
  16. Kinsey G. C., Murray M. J., Swensen S. J., Miles J. M. Glucose content of tracheal aspirates: implications for the detection of tube feeding aspiration. Crit Care Med. 1994 Oct;22(10):1557–1562. [PubMed] [Google Scholar]
  17. Newell S. J., Morgan M. E., Durbin G. M., Booth I. W., McNeish A. S. Does mechanical ventilation precipitate gastro-oesophageal reflux during enteral feeding? Arch Dis Child. 1989 Oct;64(10 Spec No):1352–1355. doi: 10.1136/adc.64.10_spec_no.1352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Nickerson B. G. A test for recurrent aspiration in children. Pediatr Pulmonol. 1987 Mar-Apr;3(2):65–66. doi: 10.1002/ppul.1950030204. [DOI] [PubMed] [Google Scholar]
  19. Nicolas E., Roy P., Descos B., Bergeat M. A., Lachaux A., Floret D., Hermier M. Reflux gastro-oesophagien acide chez l'enfant intubé, ventilé et alimenté. A propos de 28 cas. Pediatrie. 1988;43(6):563–566. [PubMed] [Google Scholar]
  20. Nussbaum E., Maggi J. C., Mathis R., Galant S. P. Association of lipid-laden alveolar macrophages and gastroesophageal reflux in children. J Pediatr. 1987 Feb;110(2):190–194. doi: 10.1016/s0022-3476(87)80152-x. [DOI] [PubMed] [Google Scholar]
  21. Orenstein S. R., Orenstein D. M. Gastroesophageal reflux and respiratory disease in children. J Pediatr. 1988 Jun;112(6):847–858. doi: 10.1016/s0022-3476(88)80204-x. [DOI] [PubMed] [Google Scholar]
  22. Pingleton S. K. Aspiration of enteral feeding in mechanically ventilated patients: how do we monitor? Crit Care Med. 1994 Oct;22(10):1524–1525. [PubMed] [Google Scholar]
  23. Pradeaux L., Boggio V., Gouyon J. B. Gastro-oesophageal reflux in mechanically ventilated preterm infants. Arch Dis Child. 1991 Jul;66(7 Spec No):793–796. doi: 10.1136/adc.66.7_spec_no.793. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Rossi A., Gottfried S. B., Higgs B. D., Zocchi L., Grassino A., Milic-Emili J. Respiratory mechanics in mechanically ventilated patients with respiratory failure. J Appl Physiol (1985) 1985 Jun;58(6):1849–1858. doi: 10.1152/jappl.1985.58.6.1849. [DOI] [PubMed] [Google Scholar]
  25. Simpson H., Hampton F. Gastro-oesophageal reflux and the lung. Arch Dis Child. 1991 Mar;66(3):277–279. doi: 10.1136/adc.66.3.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Sindel B. D., Maisels M. J., Ballantine T. V. Gastroesophageal reflux to the proximal esophagus in infants with bronchopulmonary dysplasia. Am J Dis Child. 1989 Sep;143(9):1103–1106. doi: 10.1001/archpedi.1989.02150210139034. [DOI] [PubMed] [Google Scholar]
  27. Torres A., Serra-Batlles J., Ros E., Piera C., Puig de la Bellacasa J., Cobos A., Lomeña F., Rodríguez-Roisin R. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992 Apr 1;116(7):540–543. doi: 10.7326/0003-4819-116-7-540. [DOI] [PubMed] [Google Scholar]
  28. Tovar J. A., Wang W., Eizaguirre I. Simultaneous gastroesophageal pH monitoring and the diagnosis of alkaline reflux. J Pediatr Surg. 1993 Oct;28(10):1386–1392. doi: 10.1016/s0022-3468(05)80332-x. [DOI] [PubMed] [Google Scholar]
  29. Valat C., Demont F., Pegat M. A., Saliba E., Bloc D., Besnard J. C., Laugier J. Radionuclide study of bronchial aspiration in intensive care newborn children. Nucl Med Commun. 1986 Aug;7(8):593–598. doi: 10.1097/00006231-198608000-00005. [DOI] [PubMed] [Google Scholar]
  30. Vandenplas Y., Lepoudre R., Helven R. Dependability of esophageal pH-monitoring data in infants on cutoff limits: the oscillatory index. J Pediatr Gastroenterol Nutr. 1990 Oct;11(3):304–309. doi: 10.1097/00005176-199010000-00004. [DOI] [PubMed] [Google Scholar]
  31. Venot J., Veyriras E., Vandroux J. C., Bournaud E., Gastinne H., Beck C. A simple radio-isotopic method for the detection of bronchial inhalation during intensive care. Eur J Nucl Med. 1984;9(8):343–344. doi: 10.1007/BF00252866. [DOI] [PubMed] [Google Scholar]
  32. de Groot R. E., Dik H., de Groot H. G., Bakker W. A nearly fatal tracheal obstruction resulting from a transtracheal oxygen catheter. Chest. 1993 Nov;104(5):1634–1635. doi: 10.1378/chest.104.5.1634. [DOI] [PubMed] [Google Scholar]

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