Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU

Orlando C. Kirton, Jimmy Windsor, Raymond Wedderburn, Judith Hudson-Civetta, David V Shatz, Nicholas R. Mataragas, Joseph M. Civetta

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Introduction: The purpose of our study was to evaluate the relationship between the state of splanchnic perfusion and morbidity and mortality in the hemodynamically unstable trauma patient acutely resuscitated in the ICU. Methods: Gastric intramucosal pH (pHi) was monitored in a blinded fashion in 19 consecutive critically ill trauma patients with evidence of systemic hypoperfusion (arterial pH [pHa] < 7.35, base excess >2.3 mmol/L, lactic acid >2.3 mEq/L) who received right heart catheters to guide resuscitation and subsequent hemodynamic monitoring. Design: Prospective randomized consecutive series with retrospective analysis of data. Setting: University hospital, surgical ICU. Results: The mean values of APACHE II (acute physiology and chronic health evaluation) Injury Severity Score, pHa, arterial base excess, cardiac index, oxygen delivery index, and oxygen consumption index by 24 h were similar (Student's t test, p>0.1) between survivors and nonsurvivors and between those who developed at most a single (SOF) vs multiple or an system failure (MOSF). Supranormal oxygen delivery and utilization parameters were evenly distributed among survivors and nonsurvivors and patients with SOF and MOSF (χ2, p>0.5). Ten patients had a phi <7.32 and nine patients had a phi ≤7.32 by 24 h. Fifty percent of patients with a phi <7.32 died, compared with 11% of patients with a pH ≤7 32 (χ2, p=0.07). Sixty percent of patients with a pHi <7.32 developed MOSF compared with 11% of patients with a Hi ≤7.32 (χ, p=0.03). The one patient who developed MOSF and died in the pHi ≤7.32 cohort suffered from massive head trauma and had all futile medical interventions halted. No other patients who achieved a pH ≤7.32 by hour 24 developed MOSF. Survivors with a pHi <7.32 at hour 24 had an increased ICU stay (pHi <7.32=46±15 days, pHi ≤7.32=13±9 days; p<0.01). A pHi <7.32 carried a relative risk of 4.5 for death and 5.4 for the occurrence of MOSF. Conclusion: Attainment of a pHi ≤7.32 at hour 24 carried a significantly reduced likelihood of MOSF. Being an inference of the state of regional perfusion, in a high-risk microvascular bed, gastric intraluminal tonometry should identify perfusion states of compensated or uncompensated shock during hemodynamic resuscitation of the critically ill injury patient. A low pHi appears to be a marker of postresuscitative morbidity and subsequent increased length of stay.

Original languageEnglish (US)
Pages (from-to)1064-1069
Number of pages6
JournalChest
Volume113
Issue number4
StatePublished - 1998
Externally publishedYes

Fingerprint

Viscera
Multiple Organ Failure
Resuscitation
Length of Stay
Wounds and Injuries
Survivors
APACHE
Perfusion
Critical Illness
Stomach
Hemodynamics
Cardiac Catheters
Oxygen
Morbidity
Injury Severity Score
Manometry
Craniocerebral Trauma
Oxygen Consumption
Shock
Lactic Acid

Keywords

  • Critical illness
  • Gastric shock
  • Hemodynamic monitoring
  • Intensive care unit
  • Multiple organ system failure
  • Right heart catheter
  • Surgical
  • Tonometry

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Kirton, O. C., Windsor, J., Wedderburn, R., Hudson-Civetta, J., Shatz, D. V., Mataragas, N. R., & Civetta, J. M. (1998). Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU. Chest, 113(4), 1064-1069.

Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU. / Kirton, Orlando C.; Windsor, Jimmy; Wedderburn, Raymond; Hudson-Civetta, Judith; Shatz, David V; Mataragas, Nicholas R.; Civetta, Joseph M.

In: Chest, Vol. 113, No. 4, 1998, p. 1064-1069.

Research output: Contribution to journalArticle

Kirton, OC, Windsor, J, Wedderburn, R, Hudson-Civetta, J, Shatz, DV, Mataragas, NR & Civetta, JM 1998, 'Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU', Chest, vol. 113, no. 4, pp. 1064-1069.
Kirton, Orlando C. ; Windsor, Jimmy ; Wedderburn, Raymond ; Hudson-Civetta, Judith ; Shatz, David V ; Mataragas, Nicholas R. ; Civetta, Joseph M. / Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU. In: Chest. 1998 ; Vol. 113, No. 4. pp. 1064-1069.
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abstract = "Introduction: The purpose of our study was to evaluate the relationship between the state of splanchnic perfusion and morbidity and mortality in the hemodynamically unstable trauma patient acutely resuscitated in the ICU. Methods: Gastric intramucosal pH (pHi) was monitored in a blinded fashion in 19 consecutive critically ill trauma patients with evidence of systemic hypoperfusion (arterial pH [pHa] < 7.35, base excess >2.3 mmol/L, lactic acid >2.3 mEq/L) who received right heart catheters to guide resuscitation and subsequent hemodynamic monitoring. Design: Prospective randomized consecutive series with retrospective analysis of data. Setting: University hospital, surgical ICU. Results: The mean values of APACHE II (acute physiology and chronic health evaluation) Injury Severity Score, pHa, arterial base excess, cardiac index, oxygen delivery index, and oxygen consumption index by 24 h were similar (Student's t test, p>0.1) between survivors and nonsurvivors and between those who developed at most a single (SOF) vs multiple or an system failure (MOSF). Supranormal oxygen delivery and utilization parameters were evenly distributed among survivors and nonsurvivors and patients with SOF and MOSF (χ2, p>0.5). Ten patients had a phi <7.32 and nine patients had a phi ≤7.32 by 24 h. Fifty percent of patients with a phi <7.32 died, compared with 11{\%} of patients with a pH ≤7 32 (χ2, p=0.07). Sixty percent of patients with a pHi <7.32 developed MOSF compared with 11{\%} of patients with a Hi ≤7.32 (χ, p=0.03). The one patient who developed MOSF and died in the pHi ≤7.32 cohort suffered from massive head trauma and had all futile medical interventions halted. No other patients who achieved a pH ≤7.32 by hour 24 developed MOSF. Survivors with a pHi <7.32 at hour 24 had an increased ICU stay (pHi <7.32=46±15 days, pHi ≤7.32=13±9 days; p<0.01). A pHi <7.32 carried a relative risk of 4.5 for death and 5.4 for the occurrence of MOSF. Conclusion: Attainment of a pHi ≤7.32 at hour 24 carried a significantly reduced likelihood of MOSF. Being an inference of the state of regional perfusion, in a high-risk microvascular bed, gastric intraluminal tonometry should identify perfusion states of compensated or uncompensated shock during hemodynamic resuscitation of the critically ill injury patient. A low pHi appears to be a marker of postresuscitative morbidity and subsequent increased length of stay.",
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T1 - Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU

AU - Kirton, Orlando C.

AU - Windsor, Jimmy

AU - Wedderburn, Raymond

AU - Hudson-Civetta, Judith

AU - Shatz, David V

AU - Mataragas, Nicholas R.

AU - Civetta, Joseph M.

PY - 1998

Y1 - 1998

N2 - Introduction: The purpose of our study was to evaluate the relationship between the state of splanchnic perfusion and morbidity and mortality in the hemodynamically unstable trauma patient acutely resuscitated in the ICU. Methods: Gastric intramucosal pH (pHi) was monitored in a blinded fashion in 19 consecutive critically ill trauma patients with evidence of systemic hypoperfusion (arterial pH [pHa] < 7.35, base excess >2.3 mmol/L, lactic acid >2.3 mEq/L) who received right heart catheters to guide resuscitation and subsequent hemodynamic monitoring. Design: Prospective randomized consecutive series with retrospective analysis of data. Setting: University hospital, surgical ICU. Results: The mean values of APACHE II (acute physiology and chronic health evaluation) Injury Severity Score, pHa, arterial base excess, cardiac index, oxygen delivery index, and oxygen consumption index by 24 h were similar (Student's t test, p>0.1) between survivors and nonsurvivors and between those who developed at most a single (SOF) vs multiple or an system failure (MOSF). Supranormal oxygen delivery and utilization parameters were evenly distributed among survivors and nonsurvivors and patients with SOF and MOSF (χ2, p>0.5). Ten patients had a phi <7.32 and nine patients had a phi ≤7.32 by 24 h. Fifty percent of patients with a phi <7.32 died, compared with 11% of patients with a pH ≤7 32 (χ2, p=0.07). Sixty percent of patients with a pHi <7.32 developed MOSF compared with 11% of patients with a Hi ≤7.32 (χ, p=0.03). The one patient who developed MOSF and died in the pHi ≤7.32 cohort suffered from massive head trauma and had all futile medical interventions halted. No other patients who achieved a pH ≤7.32 by hour 24 developed MOSF. Survivors with a pHi <7.32 at hour 24 had an increased ICU stay (pHi <7.32=46±15 days, pHi ≤7.32=13±9 days; p<0.01). A pHi <7.32 carried a relative risk of 4.5 for death and 5.4 for the occurrence of MOSF. Conclusion: Attainment of a pHi ≤7.32 at hour 24 carried a significantly reduced likelihood of MOSF. Being an inference of the state of regional perfusion, in a high-risk microvascular bed, gastric intraluminal tonometry should identify perfusion states of compensated or uncompensated shock during hemodynamic resuscitation of the critically ill injury patient. A low pHi appears to be a marker of postresuscitative morbidity and subsequent increased length of stay.

AB - Introduction: The purpose of our study was to evaluate the relationship between the state of splanchnic perfusion and morbidity and mortality in the hemodynamically unstable trauma patient acutely resuscitated in the ICU. Methods: Gastric intramucosal pH (pHi) was monitored in a blinded fashion in 19 consecutive critically ill trauma patients with evidence of systemic hypoperfusion (arterial pH [pHa] < 7.35, base excess >2.3 mmol/L, lactic acid >2.3 mEq/L) who received right heart catheters to guide resuscitation and subsequent hemodynamic monitoring. Design: Prospective randomized consecutive series with retrospective analysis of data. Setting: University hospital, surgical ICU. Results: The mean values of APACHE II (acute physiology and chronic health evaluation) Injury Severity Score, pHa, arterial base excess, cardiac index, oxygen delivery index, and oxygen consumption index by 24 h were similar (Student's t test, p>0.1) between survivors and nonsurvivors and between those who developed at most a single (SOF) vs multiple or an system failure (MOSF). Supranormal oxygen delivery and utilization parameters were evenly distributed among survivors and nonsurvivors and patients with SOF and MOSF (χ2, p>0.5). Ten patients had a phi <7.32 and nine patients had a phi ≤7.32 by 24 h. Fifty percent of patients with a phi <7.32 died, compared with 11% of patients with a pH ≤7 32 (χ2, p=0.07). Sixty percent of patients with a pHi <7.32 developed MOSF compared with 11% of patients with a Hi ≤7.32 (χ, p=0.03). The one patient who developed MOSF and died in the pHi ≤7.32 cohort suffered from massive head trauma and had all futile medical interventions halted. No other patients who achieved a pH ≤7.32 by hour 24 developed MOSF. Survivors with a pHi <7.32 at hour 24 had an increased ICU stay (pHi <7.32=46±15 days, pHi ≤7.32=13±9 days; p<0.01). A pHi <7.32 carried a relative risk of 4.5 for death and 5.4 for the occurrence of MOSF. Conclusion: Attainment of a pHi ≤7.32 at hour 24 carried a significantly reduced likelihood of MOSF. Being an inference of the state of regional perfusion, in a high-risk microvascular bed, gastric intraluminal tonometry should identify perfusion states of compensated or uncompensated shock during hemodynamic resuscitation of the critically ill injury patient. A low pHi appears to be a marker of postresuscitative morbidity and subsequent increased length of stay.

KW - Critical illness

KW - Gastric shock

KW - Hemodynamic monitoring

KW - Intensive care unit

KW - Multiple organ system failure

KW - Right heart catheter

KW - Surgical

KW - Tonometry

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