Prognostic value of gastric intramucosal pH in critically ill 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 pi-ii, On admission, 26 patients presented with low gastric pHi (less than or equal to 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 greater than or equal to 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, Al though 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.