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Effects of feeding on gastric tonometric measurements in critically ill children

Kentigern Thorburn1, Andrew Durward, Shane M Tibby

  • 1Department of Paediatric Intensive Care, Royal Liverpool Children's Hospital-Alder Hey, UK.

Critical Care Medicine
|January 7, 2004
PubMed

Insights

Gastric feeding in critically ill children lowers gastric intramucosal PCO2 (PiCO2) and its derived difference, while increasing gastric intramucosal pH (pHi). These findings differ from adult studies, highlighting unique pediatric responses to enteral nutrition.

Area of Science:

  • Critical Care Medicine
  • Pediatric Gastroenterology
  • Physiology

Background:

  • Gastric tonometry is used to assess tissue perfusion and metabolic status in critically ill patients.
  • Gastric intramucosal pH (pHi) and PCO2 (PiCO2) are important markers of splanchnic circulation.
  • The effect of gastric feeding on these parameters in children is not well-established.

Purpose of the Study:

  • To investigate the impact of gastric feeding on gastric intramucosal PCO2 (PiCO2), the PiCO2-arterial PCO2 difference, and gastric intramucosal pH (pHi) in critically ill children.
  • To compare these measurements during fasted and fed states using recirculating gas tonometry.

Main Methods:

  • A prospective pilot study was conducted in a pediatric intensive care unit.
  • Ten mechanically ventilated, hemodynamically stable children underwent gastric tonometry.
  • Measurements of PiCO2, PiCO2-PaCO2 difference, and pHi were taken hourly in both fasted and fed states.

Main Results:

  • Gastric feeding led to consistently lower PiCO2 measurements and PiCO2-PaCO2 differences compared to the unfed state.
  • Gastric intramucosal pH (pHi) values were significantly higher during gastric feeding.
  • Hemodynamic parameters remained stable throughout the study, and measurements did not vary over time.

Conclusions:

  • In critically ill children, gastric feeding decreases PiCO2 and the PiCO2-PaCO2 difference, while increasing pHi.
  • These physiological responses to gastric feeding in children contrast with findings reported in adult populations.
  • This suggests unique gastrointestinal responses to enteral nutrition in pediatric critical illness.
Abstract

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