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The prognostic value of gastric tonometry in severe polytrauma patients

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Objectives

First, to evaluate the prognostic value of gastric intramucosal pH (pHi) and pCO2 gap during intensive care unit (ICU) and hospital stay. Second, to compare the prognostic value of gastric tonometry parameters with APACHE II, SOFA score and blood lactate levels.

Design

Prospective cohort of trauma patients in the first 24 hours after admission to ICU.

Setting

General ICU in a university hospital.

Patients

Forty consecutive severe polytrauma patients admitted to a General ICU.

Methods

A gastric tonometer (Trip NGS Catheter, Tonometrics, Finland) was introduced into the patients' stomach. Continuous air tonometry (Tonocap, Datex Engestrom, Finland) was used to measure gastric pCO2. Gastric pHi, pCO2 gap, arterial blood gases and lactate levels were measured at admission and 6, 12, 24 hours after admission. Organ dysfunction was evaluated using SOFA score at admission and 3, 7, 10, 14, 21 and 28 days after admission. The patients were followed until death or discharge from the ICU.

Results

The mean age was 35 (14–79) years. Thirty-six were male (90%). Mortality rate was 35% (14/40). There were differences between survivors (S) and non-survivors (NS) on admission for APACHE II (13 ± 5 vs 21 ± 7, P = 0.001) and pHi (7.33 ± 0.11 vs 7.21 ± 0.20, P = 0.02). After 24 hours, pHi (7.33 ± 0.13 vs 7.15 ± 0.32, P = 0.01), pCO2 gap (12 ± 16 vs 28 ± 25 mmHg, P = 0.03), blood lactate levels (1.4 ± 0.9 vs 3.2 ± 3.4, P = 0.01) and HCO3 (24.4 ± 2.3 vs 19.3 ± 5.5, P = 0.001) were different between S and NS. First day SOFA score (5.4 ± 4.0 vs 12.1 ± 6.4, P = 0.001) was different for S and NS. Kaplan–Meir surviving curves showed significant differences for S and NS whenever gastric intramucosal acidosis (pHi >7.32 or pCO2 gap ≤ 15 mmHg) was present at admission or 24 hours later. Gastric acidosis was associated both at admission and after 24 hours with a greater ICU stay (10 vs 16 days, P = NS and 4 vs 19, P = 0.02), hospital stay (22 vs 40 days, P = 0.05 and 17 vs 28, P = NS) and SOFA score (4.3 vs 8.7, P = 0.01 and 4.9 vs 10.4, P = 0.002).

Conclusions

In severe trauma patients, gastric pHi and pCO2 gap are reliable predictors of outcome. Inadequate regional oxygenation as detected by gastric intramucosal acidosis, but not by systemic measures as blood lactate, is an important contributor to morbidity and mortality in this group of patients.

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Calvete, J., Schonhorst, L., Moura, D. et al. The prognostic value of gastric tonometry in severe polytrauma patients. Crit Care 6, P175 (2002). https://doi.org/10.1186/cc1635

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Keywords

  • Intensive Care Unit
  • HCO3
  • Trauma Patient
  • Intensive Care Unit Stay
  • Sofa Score