Gastric capnometry with air-automated tonometry predicts outcome in critically ill patients.
BACKGROUND
Contrary to tonometer gastric intramucosal pH, there is currently no validated threshold prognostic value for Pco2 gap (tonometer gastric mucosal Pco2 minus arterial Pco2) in the critically ill patient.


OBJECTIVE
To demonstrate a relationship between Pco2 gap and mortality in mechanically ventilated patients.


METHODS
Inception cohort study from a 9-month prospective survey of 95 consecutively ventilated critically ill patients in a teaching hospital.


METHODS
All the ventilated patients of the intensive care unit were included at their admission.


RESULTS
Gastric Pco2 using regional capnometry with air-automated tonometry, arterial gas, lactate, and organ system failure score were measured at admission and after 6, 12, 24, 48, 72, 96, and 120 hrs. For the entire population, the 28-day mortality was 44%. In multivariate analysis, independent predictors of death were organ system failure score (odds ratio, 2.12; 95% confidence interval, 1.02-3.14), 24-hr Pco2 gap (odds ratio, 1.57; 95% confidence interval, 1.10-2.24), and 24-hr lactate (odds ratio, 1.48; 95% confidence interval, 1.06-2.05). We found a threshold value of 20 mm Hg for Pco2 gap and 2.5 mmol/L for lactate, which was associated with a sensitivity of 0.70 and 0.72, respectively, and a specificity of 0.72 and 0.73, respectively.


CONCLUSIONS
The Pco2 gap is a marker of mortality in ventilated patients in the intensive care unit.
Levy
Bruno
B
Réanimation Médicale, Hôpital Central, Nancy, France.
Gawalkiewicz
Pascale
P
Vallet
Benoit
B
Briancon
Serge
S
Nace
Lionel
L
Bollaert
Pierre-Edouard
PE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D001784:Blood Gas Analysis / Q000379:methods*; D002245:Carbon Dioxide / Q000097:blood*; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005753:Gastric Mucosa; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome
D002245:Carbon Dioxide