Gastric tonometry in septic shock
Paediatric Intensive Care Unit, Guy's
Hospital, London
Correspondence to: Dr Mark Hatherill, Paediatric Intensive Care Unit, 9th Floor, Guy's Hospital, St Thomas' Street, London SE1 9RT.
Accepted 27 August 1997
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.
DESIGNChildren 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).
RESULTSMedian 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
7.32 within six hours (n = 3) had 100% mortality.
CONCLUSIONIn 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.
© 1998 by Archives of Disease in Childhood
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