Acid-base disarrangement and gastric intramucosal acidosis predict outcome from major trauma

Abstract

SUMMARY INTRODUCTION.This prospective non-interventional study intended to assess the prognostic value of gastric intramucosal acidosis in patients with severe trauma admitted to a medical/surgical ICU. METHODS. Gastric tonometer catheters were introduced to measure air PCO 2 level (Tonocap device) in forty consecutive critically ill trauma patients. Gastric intramucosal pH, air PCO 2 gradient, lactate and acid-base parameters were measured at admission and at 6, 12 and 24 h thereafter. RESULTS. The median age, mean APACHE II and SOFA scores were higher in nonsurvivors than in survivors (p<0.05). There were significant differences in the PCO 2 gradient between survivors and nonsurvivors at 12 and 24 hours (10±7 vs. 24±19 mmHg, 13±16 vs. 29±25 mmHg; p<0.05). Gastric intramucosal pH values were lower in nonsurvivors than in survivors, on admission and after 12 or 24 hours (p<0.05). Arterial pH and bicarbonate were lower, lactate concentration higher, and base excess more negative in nonsurvivors. Prediction of outcome (mortality and MODS) at 24 hours of ICU assessed by their ROC curves was similar (p=NS). At 24 hours, air PCO 2 gradient > 18 mmHg carried a relative risk of 4.6 for death, slightly higher than a HCO 3 <20 mEq/L (RR=4.29) or base excess of <-2 mmol/L (RR=3.65). CONCLUSION. Bicarbonate, base deficit, lactate, gastric intramucosal pH and PCO 2 gradient discriminate survivors from nonsurvivors of major trauma. A critical air PCO 2 gradient carried the greatest relative risk for death at 24 hours of ICU. Inadequate regional blood flow as detected by a critical PCO 2 gradient seems to contribute to morbidity and mortality of severe trauma patients.

Acid-Base disorders as predictors of early outcomes in major Trauma in a resource limited setting

“…There was a difference in means of serum PH, serum bicarbonate and anion gap corrected, among those that developed organ failure and those that did not, thought it was satisfactorily non-significant. However, according to previous studies using gastric PH a significant relationship occurs between organ dysfunction and low serum PH [2]. Perhaps our sample size was too small to show that the difference (only 14 patients developed secondary organ failure).…”

Studying patients of severe traumatic brain injury with severe abdominal injury in Japan

“…[21] Hemorrhaging from extracranial injuries in a patient with severe TBI tends to result in hemorrhagic shock following a reduction in base excess due to hypoperfusion of tissues, as severe TBI is obviously associated with more severe extracranial injuries than moderate TBI. [22] Such hypotension could induce a second brain insult to the head injury,[23] so hypotension may affect the outcomes in severe TBI.…”

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: parte I. Aspectos gerais e suporte hemodinâmico

“…Venous oxygen saturation, either mixed (SvO 2 ) or central (SvcO 2 ), reflects the oxygen available/consumption balance and is directly correlated with cardiac output (CO) (C) (64) Both low and high values on admission to the ICU are associated with increased mortality rates. (65) In patients with brain death, the venous saturation, as measured at the jugular bulb (reflecting brain oxygen metabolism), is increased, thereby contributing to increased SvcO 2 (as measured at vena cava superior or right atrium) (C).…”

“…Several observations have shown that blood lactate clearance is associated with successful hemodynamic resuscitation in sepsis or trauma patients (B). (64)(65)(66)71) Two trials have evaluated the usefulness of blood lactate clearance as a target for the resuscitation of septic patients (B). (72,73) One of these trials compared resuscitation guided by venous saturation versus blood lactate, and both were shown equivalent for the assessed outcomes.…”