Comparison of gastric intramucosal pH with measures of oxygen transport and consumption in critically ill patients

Gutiérrez, Guillermo; Bismar, H.; Dantzker, David R.; Silva, Norberto

doi:10.1097/00003246-199204000-00004

Cited by 199 publications

(67 citation statements)

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“…Hospital mortality rate was 38% (15/40) and 22 patients developed multiple organ dysfunction syndrome (MODS). Median ICU stay was of 5 [2][3][4][5][6][7][8][9][10][11][12] days. Fourteen patients died in the intensive care unit (five in less than 24 hours) and 25 were discharged alive from the hospital.…”

Section: Resultsmentioning

confidence: 99%

“…As in other critically ill patients admitted to an intensive care unit (ICU), multiple organ dysfunction syndrome (MODS) is the most common cause of death 2;3 . Incomplete resuscitation has been associated to development of MODS and death [4][5][6][7][8] . There is conclusive evidence that global parameters fail to accurately address the adequacy of resuscitation in a number of clinical conditions 4;6-9 , including trauma patients [10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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

Calvete¹,

Schonhorst²,

Moura³

et al. 2008

Rev. Assoc. Med. Bras.

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Calvete¹,

Schonhorst²,

Moura³

et al. 2008

Rev. Assoc. Med. Bras.

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“…5 The pHi is an indicator of tissue perfusion and its usefulness has been reported in a variety of patients. [6][7][8][9][10] In patients undergoing open-heart surgery, Fiddian-Green reported that the postoperative complication and mortality rate was high in patients with low pHi (pHi <7.32). 1 1 Landow et al 1 2 and Niinikoski et al 1 3 showed a decrease in pHi in patients undergoing cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Changes in gastric intramucosal pH and circulating blood volume following coronary artery bypass grafting

Ohki

Kunimoto

Isa

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To determine the changes in gastric intramucosal pH (pHi) following coronary artery bypass grafting (CABG) in comparison with systemic hemodynamic variables and circulating blood volume (BVc).Methods: Twenty patients who underwent CABG under mild hypothermic cardiopulmonary bypass (CPB) were included. Hemodynamic variables and the values of pHi were obtained at 3,6,12 and 24 hr after admission to the intensive care unit (ICU). The pHi was measured by gastric tonometric catheter. The BVc was measured by carbon monoxide (CO)-labeled hemoglobin (CO-Hb) dilution method (CO method) at 6 and 24 hr after ICU admission.Results: Systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) decreased with time. Systemic oxygen delivery index (DO 2 I) and systemic oxygen consumption index (VO 2 I) showed a gradual increase during the study period. By contrast, pHi decreased to the lowest value (7.26 ± 0.05) at six hours and returned to normal levels (7.34 ± 0.04) at 24 hr after ICU admission. Changes in BVc between six and 24 hr ranged from -242 ml to 978 ml (mean, 334 ± 338 ml). The pHi increased in patients whose BVc increased by > 300 ml. Mean fluid balance was negative in this period (-386 ± 667 ml; range, -1786 -+ 423 ml). Conclusion:The pHi showed the lowest value at six hours and returned to normal at 24 hr after ICU admission. The pHi increased with the decrease in vascular resistance and with the increases in BVc in this period. The improvement of pHi, an indicator of splanchnic perfusion, appears to be related to systemic vasodilatation and an increase in BVc.

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“…2 An important objective in the care of critically ill patients is to ensure the adequacy of tissue oxygenation, since tissue ischemia may result in anaerobic metabolism, cellular acidosis, and death. 3 However, at present, there is no clinically useful method to directly monitor the level of gastrointestinal tissue ischemic injury, which may be present well before shock and systemic hypoperfusion becomes evident.…”

Section: Introduction Splanchnic Hypoperfusion and Ischemia In The Crmentioning

confidence: 99%

Gastrointestinal ischemia monitoring through impedance spectroscopy as a tool for the management of the critically ill

Beltran¹,

Sacristán

2015

Exp Biol Med (Maywood)

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Impedance spectroscopy (IS) has been proposed as a tool for monitoring mucosal tissue ischemia and damage in the gut of critically ill patients resulting from shock and hypoperfusion. A specific device and system have been developed and tested for this specific application over the past 12 years by our research group. This paper reviews previously published studies as well as unpublished experimental results, and puts the whole in context and perspective to help understand this technology. Results presented include summaries of gastric reactance measurement understanding, in vivo measurements in animal models, clinical significance of the measurement, and future perspectives of clinical use of this technology. All of the experimental work done to date has been designed to determine the evolving device prototypes' performance and limitations from an instrumentation point of view. Although there are still questions to be answered with regard to the IS measurement, we conclude that we have reached enough confidence in the measurement and the device's performance and safety to begin clinically oriented research to learn how this technology may be useful in the diagnosis and management of different populations of the critically ill.

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Comparison of gastric intramucosal pH with measures of oxygen transport and consumption in critically ill patients

Cited by 199 publications

References 0 publications

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

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

Changes in gastric intramucosal pH and circulating blood volume following coronary artery bypass grafting

Gastrointestinal ischemia monitoring through impedance spectroscopy as a tool for the management of the critically ill

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