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, Donald Trunkey, C. E. Lucas, C. Hauser, H. G. Cryer, V. Eddy, T. K. Hunt, D. J. Dries

Research output: Contribution to journalArticle

121 Citations (Scopus)

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
Externally publishedYes

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Resuscitation
Oxygen Consumption
Stomach
Prospective Studies
Oxygen
Wounds and Injuries
Lactic Acid
Intra-Abdominal Hypertension
Abdominal Abscess
Anastomotic Leak
Injury Severity Score
Gangrene
Multiple Organ Failure
Bacteremia
Acidosis
Survivors
Maintenance

ASJC Scopus subject areas

  • Surgery

Cite this

Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma : A prospective, randomized study. / Ivatury, R. R.; Simon, R. J.; Havriliak, D.; Garcia, C.; Greenbarg, J.; Stahl, W. M.; Fink, M. P.; Van de Water, J. M.; Trunkey, Donald; Lucas, C. E.; Hauser, C.; Cryer, H. G.; Eddy, V.; Hunt, T. K.; Dries, D. J.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 39, No. 1, 1995, p. 128-136.

Research output: Contribution to journalArticle

Ivatury, RR, Simon, RJ, Havriliak, D, Garcia, C, Greenbarg, J, Stahl, WM, Fink, MP, Van de Water, JM, Trunkey, D, Lucas, CE, Hauser, C, Cryer, HG, Eddy, V, Hunt, TK & Dries, DJ 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, vol. 39, no. 1, pp. 128-136. https://doi.org/10.1097/00005373-199507000-00017
Ivatury, R. R. ; Simon, R. J. ; Havriliak, D. ; Garcia, C. ; Greenbarg, J. ; Stahl, W. M. ; Fink, M. P. ; Van de Water, J. M. ; Trunkey, Donald ; Lucas, C. E. ; Hauser, C. ; Cryer, H. G. ; Eddy, V. ; Hunt, T. K. ; Dries, D. J. / Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma : A prospective, randomized study. In: Journal of Trauma - Injury, Infection and Critical Care. 1995 ; Vol. 39, No. 1. pp. 128-136.
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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.",
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T1 - Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma

T2 - A prospective, randomized study

AU - Ivatury, R. R.

AU - Simon, R. J.

AU - Havriliak, D.

AU - Garcia, C.

AU - Greenbarg, J.

AU - Stahl, W. M.

AU - Fink, M. P.

AU - Van de Water, J. M.

AU - Trunkey, Donald

AU - Lucas, C. E.

AU - Hauser, C.

AU - Cryer, H. G.

AU - Eddy, V.

AU - Hunt, T. K.

AU - Dries, D. J.

PY - 1995

Y1 - 1995

N2 - 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.

AB - 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.

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