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[Effectiveness of hemodynamic treatment guided by gastric intramucosal pH monitoring]
C Calvo Rey1, F Ruza Tarrío, M A Delgado Domínguez
1Unidad de Cuidados Intensivos, Hospital Infantil La Paz.
Insights
Gastric intramucosal pH monitoring in critically ill children helps guide treatment. Normalizing this pH indicator is linked to fewer hemodynamic complications, improving patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Gastroenterology
- Hemodynamics
Background:
- Critically ill children often experience hemodynamic instability.
- Monitoring tissue oxygenation is crucial for managing these patients.
- Gastric intramucosal pH (pHi) is a potential indicator of tissue perfusion.
Purpose of the Study:
- To evaluate gastric intramucosal pH as a marker for guiding hemodynamic treatment in critically ill children.
- To assess the correlation between pHi normalization and the incidence of hemodynamic complications.
Main Methods:
- A hemodynamic treatment protocol was applied to 34 critically ill children.
- Gastric intramucosal pH was monitored, with normalization as the treatment endpoint.
- Hemodynamic complications were compared between the treatment group and a control group receiving conventional care.
Main Results:
- Treatment aimed at improving tissue oxygenation increased pHi values significantly (p = 0.014).
- Children with a pHi < 7.30 showed a high incidence of hemodynamic complications (73%).
- The control group with pHi < 7.30 had an even higher complication rate (93.8%).
Conclusions:
- Gastric intramucosal pH is a valuable indicator for optimizing hemodynamic treatment in critically ill children.
- Monitoring and normalizing pHi may help reduce the risk of hemodynamic complications.
Objective:
To determine whether gastric intramucosal pH can be used as an indicator for the treatment of critically ill children.
Methods:
A protocol for hemodynamic treatment was tested in 34 critically ill children (medical and surgical patients). Endpoint was considered as normalization of gastric intramucosal pH. Hemodynamic complications were compared with another group of critically ill patients who received conventional treatment.
Results:
Treatment designed to improve tissue oxygenation (hemodynamic stabilization, volume expansion, and dobutamine perfusion) raised pHi values from 7.25 +/- 0.04 to 7.32 +/- 0.13 (p = 0.014). Seventy-three percent of the children with pHi < 7.30 presented hemodynamic complications. These findings were compared with the results obtained in a control group of 30 critically-ill children given conventional treatment in the pediatric intensive care unit. In this group, 93.8% of the children with a pHi < 7.30 developed hemodynamic complications.
Conclusions:
We conclude that gastric intramucosal pHi can be useful as an indicator for the hemodynamic treatment of critically ill children.