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Prognostic value of gastric intramucosal pH in critically ill children

Casado-Flores, Juan MD, PhD; Mora, Emiliano MD; Perez-Corral, Francisco PhD; Martinez-Azagra, Amelia MD; Garcia-Teresa, Maria A. MD; Ruiz-Lopez, Maria J. MD

Pediatric Critical Care

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=to7.35) 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=to7.30 (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. (Crit Care Med 1998; 26:1123-1127)

From the Pediatric Intensive Care Unit, Hospital del Nino Jesus, Departamento de Pediatria, Universidad Autonoma de Madrid (Drs. Casado-Flores, Mora, Martinez-Azagra, Garcia-Teresa, and Ruiz-Lopez); and the Clinical Epidemiology Unit, Service of Internal Medicine, Hospital Ramon y Cajal (Dr. Perez-Corral), Madrid, Spain.

Address requests for reprints to: Dr. Juan Casado-Flores, Cuidados Intensivos Pediatricos, Hospital Nino Jesus, 28009 Madrid, Spain.

© Williams & Wilkins 1998. All Rights Reserved.