GASTRIC TONOMETRY IN SEPTIC SHOCK

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 paediatri c intensive care unit with a diagnosis of septic shock were prospectiv ely enrolled. A gastrointestinal tonometer (Tonometrics Division, Inst rumentarium Corporation, Helsinki, Finland) was placed into the stomac h and intramucosal pH, arterial pH, base deficit, and lactate were mea sured on admission and six hours later. Sequential data were analysed on 24 patients (17 survivors, seven non-survivors), median age 46 mont hs (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 (interqu artile range 7.18-7.35) in non-survivors (p = 0.01). There was no sign ificant difference in arterial pH, base excess, or lactate among survi vors and non-survivors. Admission pHi < 7.32 predicted mortality with sensitivity (57%), specificity (94%): and positive predictive value (8 0%). Patients with admission pHi < 7.32 who failed to improve greater than or equal to 7.32 within six hours (n = 3) had 100% mortality. Con clusion-In children with septic shock the admission pHi is significant ly lower in non-survivors. pHi is a better prognostic indicator of mor tality than either standard acid-base values or lactate. pHi < 7.32 th at does not improve within six hours is associated with a poor prognos is.