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Gastric tonometry in septic shock
M Hatherill1, S M Tibby, R Evans
1Paediatric Intensive Care Unit, Guy's Hospital, London.
Insights
Intramucosal pH (pHi) is a better predictor of mortality in pediatric septic shock than standard measures. Low admission pHi (< 7.32) indicates poor prognosis, especially if it doesn
Area of Science:
- Pediatric critical care medicine
- Septic shock pathophysiology
- Gastrointestinal tonometry
Background:
- Septic shock in children is a life-threatening condition requiring accurate prognostic markers.
- Traditional markers like arterial pH, base excess, and lactate have limitations in predicting outcomes.
- Intramucosal pH (pHi) offers a potential measure of tissue perfusion and cellular metabolic status.
Purpose of the Study:
- To evaluate the prognostic value of intramucosal pH (pHi) in pediatric septic shock.
- To examine the relationship between pHi, arterial pH, base excess, and lactate.
- To determine if pHi can predict mortality in this vulnerable patient population.
Main Methods:
- Prospective enrollment of children diagnosed with septic shock in a pediatric intensive care unit.
- Measurement of intramucosal pH (pHi), arterial pH, base deficit, and lactate on admission and 6 hours later using gastrointestinal tonometry.
- Analysis of data from 24 patients (17 survivors, 7 non-survivors).
Main Results:
- Non-survivors had significantly lower median admission pHi (7.2) compared to survivors (7.39).
- Arterial pH, base excess, and lactate did not significantly differ between survivors and non-survivors.
- Admission pHi < 7.32 predicted mortality with 94% specificity and 80% positive predictive value.
- Patients with admission pHi < 7.32 who did not improve within 6 hours had 100% mortality.
Conclusions:
- Admission intramucosal pH (pHi) is a superior prognostic indicator for mortality in pediatric septic shock compared to standard acid-base parameters and lactate.
- A low admission pHi (< 7.32) is strongly associated with increased mortality risk.
- Failure of pHi to improve within six hours in patients with initially low pHi portends a grave prognosis.
Objectives:
To investigate the prognostic value of intramucosal pH (pHi) and the relation among pHi, arterial pH, base excess, and lactate in children with septic shock.
Design:
Children admitted to the paediatric intensive care unit with a diagnosis of septic shock were prospectively enrolled. A gastrointestinal tonometer (Tonometrics Division, Instrumentarium Corporation, Helsinki, Finland) was placed into the stomach and intramucosal pH, arterial pH, base deficit, and lactate were measured on admission and six hours later. Sequential data were analysed on 24 patients (17 survivors, seven non-survivors), median age 46 months (range: 2.8-168 months).
Results:
Median pHi on admission was 7.39 (interquartile range 7.36-7.51) in survivors compared with 7.2 (interquartile range 7.18-7.35) in non-survivors (p = 0.01). There was no significant difference in arterial pH, base excess, or lactate among survivors and non-survivors. Admission pHi < 7.32 predicted mortality with sensitivity (57%), specificity (94%), and positive predictive value (80%). Patients with admission pHi < 7.32 who failed to improve > or = 7.32 within six hours (n = 3) had 100% mortality.
Conclusion:
In children with septic shock the admission pHi is significantly lower in non-survivors. pHi is a better prognostic indicator of mortality than either standard acid-base values or lactate. pHi < 7.32 that does not improve within six hours is associated with a poor prognosis.