Chest
Clinical Investigations in Critical CareThe DCO2 Measured by Gastric Tonometry Predicts Survival in Children Receiving Extracorporeal Life Support: Comparison With Other Hemodynamic and Biochemical Information
Section snippets
Clinical Series
Twenty consecutive patients who required ECLS for circulatory shock or hypoxemia were studied prospectively. This study was approved by the Hospital Ethics Committee on Human Research and informed consent was obtained from the parents of all children enrolled. We used the same technique as Krafte-Jacobs et al,10 introducing a 7F adult sigmoid tonometer (TRIP Sigmoid Catheter; Tonometrics, Inc; Bethesda, Md) into the stomach lumen via the orogastric route. All patients had a tonometer passed
RESULTS
In this series of 20 children receiving ECLS, there were 12 deaths and 8 survivors. The patient characteristics and indications for ECLS are outlined in Table 1. The deaths occurred while receiving ECLS in 7 children, and from 2 to 30 days after decannulation in the other 5. There have been no deaths after discharge from the ICU. The first PiCO2 measurement and first PaCO2 measurement for each patient after stabilization on a regimen of ECLS, taken anytime from 0.5 to 8 h after cannulation, are
DISCUSSION
We have shown that measures made by gastric tonometry predict survival and death in children receiving ECLS. The finding that Dco2 had greater predictive power than pHi suggests that Dco2 is a more specific indicator of poor regional perfusion. The pHi calculation is influenced by systemic metabolic acidosis, as arterial blood bicarbonate concentration is part of the Henderson-Hasselbalch equation. In addition, there is no correction in the pHi calculation for the influence of PaCO2 on PiCO2.
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