Gastric mucosal pH as a prognostic index of mortality in critically ill patients

Doglio, G. R.; Pusajo, J. F.; Egurrola, Monica A.; Bonfigli, G. C.; Parra, Carlos; Vetere, Liliana; Hernández, M.S.; Fernández, S. Pita; Pálizas, Fernando; Gutiérrez, Guillermo

doi:10.1097/00003246-199108000-00011

Cited by 452 publications

(140 citation statements)

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“…Since 1991, Doglio et al [2] and Gutierrez et al [3] have advocated pHi measurement as a method for the early detection of a reduced gastrointestinal blood flow. Determination of pHi may serve as a tool to assess the prognosis of critically ill patients.…”

mentioning

confidence: 99%

Improved P CO₂ measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry

Knichwitz¹,

Mertes²,

Kuhmann³

1995

Anaesthesia

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The measurement of gastric intramucosal pH serves as a non-invasive technique for early detection of gastrointestinal ischaemia in critically illpatients. The method is based on the determination of the partialpressure of carbon dioxide in a 0.9% saline solution using a standard bloodgas analyser. However, the use of standard bloodgas analysers leads to an underestimation of carbon dioxide partial pressure in saline. Instrumental biases of six blood gas analysers were investigated using either a saline or a phosphate-buffered solution. Both test solutions were equilibrated with Jive defined carbon dioxide concentrations. Each blood gas analyser underestimated this dejinedpartial pressure of carbon dioxide with a bias between -3.7% and -57.5% if saline was used. The phosphate-buffered solution considerably improved instrumental precision, resulting in biases between -k 2.7% and -17.6%. Thus, a phosphate-buffered solution increases the accuracy of gastric intramucosal pH measurement.

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mentioning

confidence: 99%

Improved P CO₂ measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry

Knichwitz¹,

Mertes²,

Kuhmann³

1995

Anaesthesia

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“…Patients with low pHi at zero hours have a higher mortality particularly if pHi does not improve with intervention within 24 hours [2,11,13,14]. A large difference in the partial pressure of carbon dioxide between gastric mucosa and arterial blood (PgCO 2 -PaCO 2 ) has been shown to be more specific indicator of splanchnic ischemia and predictors of outcome [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…The stomach is one of the first organs to suffer from hypoperfusion and the last to be restored to normality by resuscitation [2]. These alterations are reflected by increase in the gastric intramucosal pH (pHi) and carbon dioxide (CO 2 ).…”

Section: Original Articlementioning

confidence: 99%

“…The carbon dioxide produced in the mucosal cells being freely diffusible, equilibrates across the semi-permeable membrane of the balloon. Low pHi is associated with poor out come [2,3] and it can serve as a marker of inadequate tissue perfusion/ oxygenation (shock) and an end point of resuscitation [2,[4][5][6][7].Measurement of gastric intramucosal pH provides a measure of tissue acid base balance in a region of the body that is among the first to develop dysoxia in shock and sepsis [8,9].…”

Section: Original Articlementioning

confidence: 99%

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Gastric Tonometry as a Prognostic Index of Mortality in Sepsis

Upadhyay

Vp²,

Murthy

2007

Medical Journal Armed Forces India

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Background: Splanchnic hypoperfusion in sepsis leads to translocation of bacteria from gut and development of multi-organ dysfunction syndrome (MODS), with increased mortality in critically ill patients. Gastric tonometry can detect this hypoperfusion by measuring carbon dioxide tension (PgCO 2 ) and intramucosal pH (pHi) from gastric mucosa. Therapeutic intervention aimed at improving gut perfusion can improve the outcome and prognosticate the mortality in sepsis patients. Methods: 100 patients with clinical diagnosis of sepsis were included and divided into two groups of 50 each. Group A patients were managed traditionally without gastric tonometry and in Group B gastric tonometry was used for therapeutic intervention. The intramucosal PCO 2 , pHi, end tidal carbon dioxide tension (EtCO 2 ) and (PgCO 2 -EtCO 2 ) differences were monitored at 0, 12 and 24 hours interval. Result: Overall mortality in Group A was 64% and 54% in Group B. In Group B 45% patients developed MODS and 54% died with low pHi. As an index of mortality low pHi had a sensitivity of 70% and specificity of 65%. Conclusion: There is a good correlation between mortality prediction on the basis of pHi and PgCO 2 -EtCO 2 difference and actual mortality in critically ill patients. The gastric tonometer should be used to predict mortality and guide resuscitation in septicemia.

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“…[9][10][11][12][13] It's predictive value, after an initial period of treatment in the intensive care unit, has been conflicting. However, those trials have several limitations.…”

Section: Outcome Predictionmentioning

confidence: 99%

Gas tonometry for evaluation of gastrointestinal mucosal perfusion: experimental and clinical sepsis¹. part 2

Silva

Figueiredo

Cruz³

et al. 2002

Acta Cir. Bras.

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Severe sepsis and septic shock are associated with high morbidity and mortality, due to multiple organ dysfunction syndrome. Substantial clinical and animal evidences indicate that the mesenteric circulatory bed, particularly the gut mucosa, is highly vulnerable to reductions in oxygen supply and prone to early injury in the course of hemodynamic changes. We have presented our experience with gas tonometry in experimental models of trauma, shock and complex surgical maneuvers 1 . We also analyzed the concepts of the tonometric method and how PCO 2 is a marker of blood flow and tissue hypoxia. 1 In the present issue, we further analyze the role of gas tonometry in experimental and clinical sepsis and septic shock. Pathophysiology of tissue hypercarbia in sepsisThere are many reasons for the development of gastric mucosal hypercarbia in septic patients. Metabo-1. Studies performed at

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Gastric mucosal pH as a prognostic index of mortality in critically ill patients

Cited by 452 publications

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Improved P CO₂ measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry

Improved P CO₂ measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry

Gastric Tonometry as a Prognostic Index of Mortality in Sepsis

Gas tonometry for evaluation of gastrointestinal mucosal perfusion: experimental and clinical sepsis¹. part 2

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Gastric mucosal pH as a prognostic index of mortality in critically ill patients

Cited by 452 publications

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Improved P CO2 measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry

Improved P CO2 measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry

Gastric Tonometry as a Prognostic Index of Mortality in Sepsis

Gas tonometry for evaluation of gastrointestinal mucosal perfusion: experimental and clinical sepsis¹. part 2

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Product

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Improved P CO₂ measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry

Improved P CO₂ measurement in six standard blood gas analysers using a phosphate‐buffered solution for gastric tonometry