title: 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 (PgCO2) 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 PCO2, pHi, end tidal carbon dioxide tension (EtCO2) and (PgCO2-EtCO2) differences were monitored at 0, 12 and 24 hours interval.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  There is a good correlation between mortality prediction on the basis of pHi and PgCO2-EtCO2 difference and actual mortality in critically ill patients. The gastric tonometer should be used to predict mortality and guide resuscitation in septicemia.
authors.affiliation: Associate Professor (Department of Anaesthesiology and Critical Care), Armed Forces Medical College, Pune-411040.
authors.forename: K K
authors.initials: KK
authors.lastname: Upadhyay
authors.affiliation: ADMS, HQ Western Command, Army Hospital (R&R), Delhi Cantt.
authors.forename: V P
authors.initials: VP
authors.lastname: Singh
authors.affiliation: Senior Advisor (Neuroanaesthesia), Army Hospital (R&R), Delhi Cantt.
authors.forename: Tvsp
authors.initials: T
authors.lastname: Murthy
keywords: Gastric tonometry; Multi-organ dysfunction syndrome; Sepsis; Splanchnic hypoperfusion