Introduction: Shock-induced gut ischemia-reperfusion has been implicated in adult respiratory distress syndrome and multiple organ failure (ARDS/MOF), i.e. organ failure (OF). Regional gastric mucosal PCO2 (PrCO2) continuously monitored by automated gas tonometry (Datex-Ohmeda/Tonometrics, Helsinki) indicates gut hypoperfusion. We compared PrCO2 during resuscitation in patients at risk for OF to determine if PrCO2 is a tissue-specific early discriminator of OF. Methods: Major torso trauma patients at known risk for OF have radial artery, pulmonary artery and gastric tonometer catheters placed on ICU admission, and are resuscitated by hemoglobin replacement and volume loading in a standardized 24-hr protocol to obtain O2 delivery index (DO2I) ≥600 mL/min/m2. DO2I, PrCO2, serum lactate and base deficit (BD) were compared at 4 hr intervals using ANOVA. ARDS and MOF were determined using standard criteria. Results: The table summarizes data from 34 major torso trauma patients admitted 10/97-8/98 (85% blunt; age 41±3 yr; 74% male; ISS 28±2). 12 patients (35%) developed OF (3 ARDS and 9 MOF). Variable (mean±sem) ICU admit 4 hr 8 hr 16 hr 24 hr no OF (n=22) DO2I (mL/min/m2) 496±27 537±40 555±43 614±31 633±35 PrCO2(torr) 43±2 43±2 47±2 52±3 53±4 lactate (mM) 5.3±0.6 5.0±0.5 4.2±0.4 3.2±0.6 3.0±0.6 BD (mEq/L) 6.8±0.9**6.2±0.8**3.5±0.8* *3.2±0.6**2.3±0.9 OF (n=12) Note:*P<0.05 re: no OF;**P<0.05 re: ICU admit DO2I (mL/min/m2)*335±39 455±45**531±38 561±33**670±41 PrCO2(torr)*52±4*56±6*59±7 53±7 54±6 lactate (mM) 7.5±1.1 7.5±1.2*6.5±1.1 5.5±0.9 5.1±1.2 BD (mEq/L)*10.3±2.1**6.8±1.4**4. 0±1.1**1.6±0.7**1.6±0.9 On ICU admission and for 8 hrs, PrCO2 in the OF group was greater than that of the non OF group, after which PrCO2 was similar for both groups. On ICU admission, the OF group had lower DO2I and higher BD; DO2I and BD were similar for both groups at 4 hrs. Lactate was greater in the OF group at 8 and 12 hrs. Both groups attained DO2I≥600 mL/min/m2 within 24 hrs. Conclusions: Early gut hypoperfusion, indicated by elevated PrCO2, is an early discriminator of OF, suggesting that gut ischemia-reperfusion is an inciting event. Prevention of gut ischemia-reperfusion may preclude OF.
|Original language||English (US)|
|Journal||Critical Care Medicine|
|Issue number||1 SUPPL.|
|State||Published - 1999|
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine