Relationship between ventilator-associated pneumonia and intramucosal gastric pHi: a case-control study.
OBJECTIVE
Prior investigations have suggested a clear relationship between nosocomial pneumonia and intramucosal gastric pH (pHi), a probable marker of bacterial translocation.


METHODS
We studied 33 patients (18 with pneumonia and 15 without) admitted to an intensive care unit and hospitalized longer than 72 hours with the aim of assessing the relationship between nosocomial pneumonia, pHi, and outcome. pHi was estimated at the time of inclusion of patients into the study. Arterial pH (pHa) and bicarbonate and stomach pH and tonometer PtCO2 were also recorded. Values of < 7.32 or delta pHa-pHi of > +0.06 were used to differentiate between normal and low pHi. Quantitative cultures of pharyngeal swabs, gastric lumen, and protected specimen brush from lower airways were also done.


RESULTS
The mean pHi values were 7.397 +/- 0.105 (range, 7.14 to 7.53) and 7.452 +/- 0.059 (range, 7.37 to 7.56) for patients with and without pneumonia, respectively (P = .073). Five patients, all with pneumonia, had pHi < 7.32. No patients without pneumonia had pHi < 7.32 (P = .04). The mean delta pHa-pHi was 0.04 +/- 0.07 (range, -0.11 to 0.13) and 0.05 +/- 0.09 (range, -0.09 to 0.28; P = .72) for patients with and without pneumonia, respectively. However, there were significant differences when tonometer PtCO2 values of both groups were compared (38.9 +/- 8.3 and 30.6 +/- 4.7 mm Hg, respectively; P = .025). Patients with pneumonia had higher alkaline gastric lumen pH (5.2 +/- 1.0) than those without pneumonia (3.8 +/- 1.4; P = .006). Nonsurvivors (n = 7) had more acidic pHi (7.33 +/- 0.11) than survivors (7.44 +/- 0.06; P = .045). The mean gastric lumen bacterial concentration was 4.14 +/- 1.01 Log10 CFU/mL in patients with pneumonia and 4.28 +/- 1.22 Log10 CFU/mL in patients without pneumonia (P = NS). When patients with and without intramucosal gastric acidosis (pHi < 7.32) were compared, the gastric bacterial burden was 4.42 +/- 0.82 Log10CFU/mL and 4.32 +/- 1.03 Log10 CFU/mL (P = .08), respectively.


CONCLUSIONS
Most patients with nosocomial pneumonia had no associated intramucosal gastric acidosis. However, low pHi was associated with increased mortality.
Department de Medicina, Hospital Clínic, Universitat de Barcelona, Spain.
C
C
Hernández
M
M
el-Ebiary
J
J
Gonzalez
J P
JP
de la Bellacasa
C
C
Montón
A
A
Torres
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D016022:Case-Control Studies; D003428:Cross Infection / Q000378:metabolism* / Q000382:microbiology; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism* / Q000382:microbiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000378:metabolism* / Q000382:microbiology / Q000635:transmission; D012122:Ventilators, Mechanical / Q000009:adverse effects