Gastric Tonometry as a Prognostic Index of Mortality in Sepsis

Abstract

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.

Blood transfusion practices in sepsis

“…It can be used to detect gut hypoxia by calculating the gastric to arterial pCO 2 gap. [ 8 ] Additional laboratory studies that help characterise the severity of sepsis include a low platelet count, and elevated international normalized ratio (INR), creatinine, and bilirubin.…”

Monitoring technologies in the neonatal intensive care unit: implications for the detection of necrotizing enterocolitis

“…The intramucosal pH has been shown to be a valuable indicator of gut ischemia, 19 early hypovolemia, 20 mortality and sepsis. 21 Gastric tonometry has been applied to two term infants with hypoplastic left heart syndrome, which is generally regarded to be a risk factor for NEC. 22 The patient with a significant decrease in gastric intramucosal pH (<7.32) was diagnosed with NEC by radiography, which was confirmed at post-mortem examination.…”