Markers of tissue hypoperfusion in pediatric septic shock

Objective:To describe measurements of global oxygenation parameters, marker s of splanchnic hypoperfusion and those of metabolic activity related to ce llular energy production among critically ill children with septic shock. Design: Clinical study of a series of cases. Patients and participants: 11 previously healthy children with septic shock admitted to the pediatric intensive care unit (ICU) of a university hospit al. Interventions: None. Measurements and results: Oxygen consumption, oxygen delivery (DO2), serum bicarbonate, arterial pH, gastric intramucosal pH (pHi), gastroarterial car bon dioxide tension gradient, serum lactate, pyruvate, lactate to pyruvate ratio (LIP), ketone body ratio, and the esterified to free carnitine ratio were measured serially at 0, 6, 12, 24, 36, and 48 h after admission to the pediatric ICU. All children survived. One patient failed to show supranorm al DO2 (> 570 ml/min per m(2)). Normalization of serum bicarbonate and lact ate were associated with patient recovery. One patient presented an increas ingly abnormal Li P ratio with normal lactate levels, suggesting an increas ed utilization of pyruvate rather than an increased cytosolic redox potenti al. Although values of gastric pHi < 7.30 were observed in 43 % of samples, serial measurements in individuals showed significant variability and unpr edictable trends. Free fatty acid concentrations, ketone body production, a nd carnitine levels remained within the normal range. Conclusions: In this study, trends in serum bicarbonate and lactate somewha t characterized the recovery of children with septic shock. Based on our da ta, it is unclear how other markers may have been used to modify therapy.