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Prognostic value of gastric intramucosal pH in critically ill children
J Casado-Flores1, E Mora, F Pérez-Corral
1Hospital del Niño Jesús, Departamento de Pediatría, Universidad Autónoma de Madrid, Spain.
Insights
Gastric intramucosal pH (pHi) is a key indicator of mortality risk in critically ill children. Lower pHi levels significantly correlate with increased death rates, highlighting its prognostic value in pediatric intensive care units.
Area of Science:
- Critical Care Medicine
- Pediatric Physiology
- Gastroenterology
Background:
- Critically ill children face high risks of mortality and multiple organ dysfunction syndrome (MODS).
- Early identification of prognostic markers is crucial for timely intervention in pediatric intensive care units (ICUs).
Purpose of the Study:
- To investigate the association between tonometrically measured gastric intramucosal pH (pHi) and outcomes in critically ill children.
- To evaluate pHi as a predictor for MODS and mortality in this vulnerable population.
Main Methods:
- A prospective, observational study was conducted in a pediatric ICU.
- Gastric intramucosal pH (pHi) was measured daily using a tonometric catheter in 51 critically ill children.
- Logistic regression analysis was employed to assess the prognostic value of pHi and Pediatric Risk of Mortality (PRISM) scores.
Main Results:
- Children with a gastric pHi <7.30 exhibited a significantly higher mortality rate (47.1%) compared to those with pHi ≥7.30 (11.7%).
- Both admission gastric pHi and PRISM score were identified as independent predictors of mortality.
- No significant association was found between gastric pHi and the development of MODS.
Conclusions:
- Gastric intramucosal pH (pHi) serves as an independent predictor of mortality in critically ill pediatric patients.
- While not a predictor for MODS, the trend suggests a potential link requiring further investigation.
- Tonometric pHi measurement is a minimally invasive and well-tolerated procedure in children.
Objective:
To determine the association of tonometrically measured gastric intramucosal pH (pHi) to the occurrence of multiple organ dysfunction syndrome (MODS) and death in critically ill children.
Design:
Prospective, observational study.
Setting:
Pediatric intensive care unit (ICU) of a teaching children's hospital.
Patients:
Fifty-one critically ill children admitted (median age 5.4+/-5 [SD] yrs; range 1 mo to 16 yrs) with the following diagnoses: post major surgery (n=26), sepsis (n=8), multiple trauma (n=5), acute respiratory distress syndrome (n=4), and "miscellaneous" (n=8).
Interventions:
Placement of a tonometric catheter.
Measurements And Main Results:
Pediatric Risk of Mortality (PRISM) score and clinical data were collected on admission and pHi daily during their stay in the pediatric ICU. A sigmoid tonometer was used to determine the pHi. Unconditional logistic regression was used to investigate the prognostic value of pHi. On admission, 26 patients presented with low gastric pHi (< or =7.35) and 17 of them had values of <7.30. The mortality rate in children with pHi <7.30 was 47.1% (95% confidence interval, 26.2 to 69) in contrast with an 11.7% mortality rate (95% confidence interval, 4.6 to 26.6) in children having a pHi of > or =7.30 (p=.015). The pHi and PRISM score on admission were independent predictive factors of death. The risk of mortality is increased when the pHi is low (odds ratio=2.5). However, we did not find the pHi to be a predictor for developing MODS.
Conclusions:
Our results show that pHi is an independent predictor of mortality in patients admitted to a pediatric ICU. Although no relationship was observed between the risk of MODS and gastric pHi, the univariate difference of 21% vs. 41% is highly suggestive. The pHi determination is a minimally invasive procedure and well tolerated in children of all ages.