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Validity of gastric intramucosal pH (pHi) for circulatory evaluation in pediatric patients
Tomono Kishimoto1, Yuji Fujino, Shinya Nishimura
1Intensive Care Unit, Osaka University Hospital, Suita, Japan.
Insights
Gastric intramucosal pH (pHi) measurement is a useful tool for assessing circulatory status in critically ill children. A pHi above 7.11 correlated with venous oxygen saturation, aiding in perfusion evaluation.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Hemodynamics
Background:
- Assessing circulatory status in critically ill pediatric patients is challenging.
- Non-invasive or minimally invasive monitoring tools are crucial for timely intervention.
Purpose of the Study:
- To evaluate the utility of gastric intramucosal pH (pHi) for assessing circulatory status in critically ill pediatric patients.
- To determine if pHi measurements correlate with other hemodynamic parameters.
Main Methods:
- A prospective clinical study was conducted in a general pediatric intensive care unit.
- Gastric intramucosal pH (pHi) was measured using tonometric catheters in seven critically ill children.
- Simultaneous measurements included venous blood oxygen saturation (SvO2), arterial keton body ratio (AKBR), and serum lactate levels.
Main Results:
- A pHi below 7.22 was associated with non-survival.
- pHi above 7.11 showed a significant positive correlation with SvO2 (r = 0.814, p < 0.001).
- AKBR and serum lactate levels did not correlate with pHi, suggesting pHi is a more specific indicator of perfusion.
Conclusions:
- Gastric intramucosal pH (pHi) is a valuable parameter for evaluating the circulatory status of critically ill pediatric patients.
- pHi provides reliable assessment of splanchnic and peripheral perfusion.
- This method can aid in guiding therapeutic interventions for improved outcomes.
Objective:
To determine if the measurement of gastric intramucosal pH (pHi) is useful for evaluation of circulatory status of critically ill pediatric patients.
Design:
Prospective clinical study.
Setting:
General intensive care unit in a university hospital.
Patients:
Seven pediatric patients (mean age: 2 y.o.); six post-cardiac surgery, one receiving barbiturate therapy.
Interventions:
Tonometric catheters were placed via nasogastric approach. pHi was measured after confirmation of the catheter position by X-ray.
Measurements And Main Results:
Saturation of venous blood oxygen (SvO2), arterial keton body ratio (AKBR), serum lactate level and pHi were evaluated simultaneously. No patients survived with pHi below 7.22; pHi above 7.11 significantly correlated with SvO2 values (r = 0.814, p < 0.001); pHi below 7.11 did not show any significant correlation with SvO2. Whereas SvO2 values of under 40% were distributed in the pHi range from 7.11 to 7.19, pHi below 7.11 occurred when SvO2 values were more than 40%. AKBR and serum lactate level did not correlate with pHi.
Conclusion:
pHi can be a useful parameter for evaluating the circulatory status of critically ill pediatric patients; it allows reliable evaluation of splanchnic and peripheral perfusion.