Assessment of Splanchnic Oxygenation by Gastric Tonometry in Patients with Acute Circulatory Failure

Maynard, Nicholas; Bihari, David; Beale, Richard; Smithies, Mark; Baldock, G.; Mason, Robert C.; McColl, Ian

doi:10.1097/00132586-199402000-00001

Cited by 69 publications

(83 citation statements)

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“…The technique of gastric tonometry was initially validated in animals,13 and increasing clinical use has shown the close association between low pHi, morbidity, and mortality in adults 411 14-16 Indeed, although adult studies have suggested that pHi is superior to conventional haemodynamic variables as a prognostic factor,11 use of this modality in paediatric practice has been restricted to a few centres 5…”

Section: Discussionmentioning

confidence: 99%

“…Gastric tonometry has become routine in many adult intensive care units to monitor the course of haemodynamically unstable patients, as intramucosal acidosis may reflect a critical reduction of oxygen delivery to the hepatosplanchnic circulation, with the consequent risk of multiorgan failure (MOF) and death 4. This deterioration in intramucosal pH (pHi) often occurs before changes are detected in cardiac output or biochemical variables.…”

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confidence: 99%

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Gastric tonometry in septic shock

Hatherill

Tibby

Evans

et al. 1998

Archives of Disease in Childhood

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Objectives-To investigate the prognostic value of intramucosal pH (pHi) and the relation among pHi, arterial pH, base excess, and lactate in children with septic shock. Design-Children admitted to the paediatric intensive care unit with a diagnosis of septic shock were prospectively enrolled. A gastrointestinal tonometer (Tonometrics Division, Instrumentarium Corporation, Helsinki, Finland) was placed into the stomach and intramucosal pH, arterial pH, base deficit, and lactate were measured on admission and six hours later. Sequential data were analysed on 24 patients (17 survivors, seven nonsurvivors), median age 46 months (range: 2.8-168 months). Results-Median pHi on admission was 7.39 (interquartile range 7.36-7.51) in survivors compared with 7.2 (interquartile range 7.18-7.35) in non-survivors (p = 0.01). There was no significant diVerence in arterial pH, base excess, or lactate among survivors and non-survivors. Admission pHi < 7.32 predicted mortality with sensitivity (57%), specificity (94%), and positive predictive value (80%). Patients with admission pHi < 7.32 who failed to improve > 7.32 within six hours (n = 3) had 100% mortality. Conclusion-In children with septic shock the admission pHi is significantly lower in non-survivors. pHi is a better prognostic indicator of mortality than either standard acid-base values or lactate. pHi < 7.32 that does not improve within six hours is associated with a poor prognosis. (Arch Dis Child 1998;78:155-158)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Gastric tonometry in septic shock

Hatherill

Tibby

Evans

et al. 1998

Archives of Disease in Childhood

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“…2 However, the exact pathogenetic mechanism is still unclear and has been the subject of substantial research efforts.…”

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confidence: 99%

The endothelin receptor antagonist bosentan restores gut oxygen delivery and reverses intestinal mucosal acidosis in porcine endotoxin shock

Oldner

Wanecek

Goiny

et al. 1998

Gut

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Background-Endothelin-1, the most potent vasoconstrictor known, is produced in septic states and may be involved in the pathophysiology of the deteriorated splanchnic circulation seen in septic shock. Aims-To elucidate the capability of bosentan, a non-peptide mixed endothelin receptor antagonist, to attenuate splanchnic blood flow disturbances and counteract intestinal mucosal acidosis in endotoxic shock. Methods-In 16 anaesthetised pigs, central and regional haemodynamics were monitored by thermodilution and ultrasonic flow probes, respectively. A tonometer in the ileum was used for measurement of mucosal pH. Onset of endotoxin challenge was followed by bosentan administration (to eight pigs) two hours later. Results-Endotoxin infusion reduced cardiac index and systemic oxygen delivery; bosentan restored these parameters. The reduced mean arterial blood pressure and renal blood flow remained unaVected by bosentan. The profound reduction in gut oxygen delivery in response to endotoxin was completely abolished by bosentan. Bosentan significantly improved the notably deteriorated intestinal mucosal pH and mucosal-arterial PCO 2 gap. The mucosal-portal vein PCO 2 gap, used to monitor the mucosa in relation to the gut as a whole (including the spleen and pancreas), was also greatly increased by endotoxaemia and significantly reversed by bosentan. Conclusion-Bosentan completely restored the profound endotoxin induced reductions in systemic and gut oxygen delivery with a concomitant reversal of intestinal mucosal acidosis. Results suggest that endothelin is involved in the pronounced perfusion disturbances seen in the gut in endotoxic shock. Bosentan may prove useful in reducing gut ischaemia in septic shock. (Gut 1998;42:696-702)

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“…In patients with critical illness who have bouts of hypotension—and therefore hypoperfusion—with resultant ischaemia to multiple organ systems, GIBs are considered a manifestation of the entire disease process 6. Even when systemic circulation is maintained, there could still be intestinal hypoperfusion 8 9. Common medications used in intensive care units (ICUs) have been implicated as contributing to GIB: opiates and sedatives for intubated patients are associated with decreases in gut motility and venous return, as are vasopressors 10 11…”

Section: Introductionmentioning

confidence: 99%