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Gastric tonometry in septic shock

M Hatherill1, S M Tibby, R Evans

  • 1Paediatric Intensive Care Unit, Guy's Hospital, London.

Archives of Disease in Childhood
|May 14, 1998
PubMed
Summary

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

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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.

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