Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma: A prospective, randomized study

R. R. Ivatury, R. J. Simon, D. Havriliak, C. Garcia, J. Greenbarg, W. M. Stahl, M. P. Fink, J. M. Van de Water, D. D. Trunkey, C. E. Lucas, C. Hauser, H. G. Cryer, V. Eddy, T. K. Hunt, D. J. Dries

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    121 Scopus citations

    Abstract

    Objective: To compare gastric mucosal pH (pHi) and global oxygen variables [Oxygen Delivery Index (DO2I) and Oxygen Consumption index (VO2I)] as indicators of adequacy of resuscitation after major trauma. Methods: Twenty- seven patients were prospectively randomized into two groups: group 1 (n = 11), normalization and maintenance of pHi at or above 7.30; and group 2 (n = 16), maintaining a DO2I of 600 and a VO2I of > 150. The groups had statistically similar injury severity scores, lactate, and base deficit. Results: The goals of therapy were achieved within 24 hours of admission in 10 of the 11 patients in group 1 and in 15 of the 16 patients in group 2. One patient (9.1%) in group 1 died. This patient had transient stabilization of pHi to 7.3 and subsequently had persistent mucosal acidosis. Of the 10 patients with pHi > 7.3 at 24 hours, 9 survived. In group 2, 5 (31.3%) died. Four of the 5 nonsurvivors had achieved DO2I and VO2I goals, but had pHi < 7.3 at 24 hours. A comparison of time taken for optimization of DO2I, VO2I, lactate, base excess, and pHi showed pHi and lactate as the variables different in survivors and nonsurvivors. Six of the 8 patients who developed multiple organ dysfunction syndrome had pHi < 7.3 at 24 hours. Persistently low phi was the first sign of bacteremia (3 patients), small bowel gangrene or pregangrene (2 patients), intestinal anastomotic leak (2 patients), intra- abdominal hypertension (4 patients), and intra-abdominal abscess (5 patients). It was the first finding in all the nonsurvivors at least 72 hours before death. Conclusions: pHi may be an important marker to assess the adequacy of resuscitation. pHi monitoring may provide early warning for systemic complications in the postresuscitation period.

    Original languageEnglish (US)
    Pages (from-to)128-136
    Number of pages9
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume39
    Issue number1
    DOIs
    StatePublished - 1995

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

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    Ivatury, R. R., Simon, R. J., Havriliak, D., Garcia, C., Greenbarg, J., Stahl, W. M., Fink, M. P., Van de Water, J. M., Trunkey, D. D., Lucas, C. E., Hauser, C., Cryer, H. G., Eddy, V., Hunt, T. K., & Dries, D. J. (1995). Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma: A prospective, randomized study. Journal of Trauma - Injury, Infection and Critical Care, 39(1), 128-136. https://doi.org/10.1097/00005373-199507000-00017