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The Impact of Antioxidant and Splanchnic-Directed Therapy on Persistent Uncorrected Gastric Mucosal pH in the Critically Injured Trauma Patient

1998; Lippincott Williams & Wilkins; Volume: 44; Issue: 2 Linguagem: Inglês

10.1097/00005373-199802000-00022

1529-8809

Erik Barquist, Orlando C. Kirton, Jimmy Windsor, Judith Hudson-Civetta, Mauricio Lynn, Michael V. Herman, Joseph M. Civetta,

Sepsis Diagnosis and Treatment

Background Critically ill trauma patients with gastric intramucosal acidosis, as measured by gastric tonometry, have an increased incidence of multiple organ dysfunction syndrome despite supranormal O2 delivery. We altered our resuscitation protocol to maximize splanchnic blood flow and decrease oxygen-derived free radical damage. Design Prospective clinical trial with historical controls. Methods The protocol differed from control by including administration of folate, mannitol, and low-dose isoproterenol. All patients had gastric tonometers and pulmonary artery catheters. If the intramucosal pH (pHi) was less than 7.25, splanchnic-sparing inotropic and vasodilatory agents were used to optimize systemic cardiac output. Two groups of trauma patients with persistent intramucosal acidosis at 24 hours (pHi < 7.25) were compared: a control group (n = 7), and patients who received the splanchnic/antioxidant protocol (n = 13). Results The two groups were similar based on Acute Physiology and Chronic Health Evaluation II score, Injury Severity Score, age, cardiac index, oxygen delivery, and oxygen consumption. The "splanchnic therapy" group had fewer organ system failures as well as shortened length of intensive care unit and hospital stay. Three of 7 patients in the control group and 2 of 13 patients in the splanchnic therapy group had a final pHi < 7.25. Conclusion Gastric tonometry-guided resuscitation and antioxidant/splanchnic therapy in critically ill trauma patients with persistent gastric mucosal acidosis may decrease multiple organ dysfunction syndrome.