The impact of antioxidant and splanchnic-directed therapy on persistent uncorrected gastric mucosal pH in the critically injured trauma patient.
BACKGROUND
Critically ill trauma patients with gastric intramucosal acidosis, as measured by gastric tonometry, have an increased incidence of multiple organ dysfunction syndrome despite supranormal O2 delivery. We altered our resuscitation protocol to maximize splanchnic blood flow and decrease oxygen-derived free radical damage.


METHODS
Prospective clinical trial with historical controls.


METHODS
The protocol differed from control by including administration of folate, mannitol, and low-dose isoproterenol. All patients had gastric tonometers and pulmonary artery catheters. If the intramucosal pH (pHi) was less than 7.25, splanchnic-sparing inotropic and vasodilatory agents were used to optimize systemic cardiac output. Two groups of trauma patients with persistent intramucosal acidosis at 24 hours (pHi < 7.25) were compared: a control group (n = 7), and patients who received the splanchnic/antioxidant protocol (n = 13).


RESULTS
The two groups were similar based on Acute Physiology and Chronic Health Evaluation II score, Injury Severity Score, age, cardiac index, oxygen delivery, and oxygen consumption. The "splanchnic therapy" group had fewer organ system failures as well as shortened length of intensive care unit and hospital stay. Three of 7 patients in the control group and 2 of 13 patients in the splanchnic therapy group had a final pHi < 7.25.


CONCLUSIONS
Gastric tonometry-guided resuscitation and antioxidant/splanchnic therapy in critically ill trauma patients with persistent gastric mucosal acidosis may decrease multiple organ dysfunction syndrome.
Barquist
E
E
Department of Surgery, University of Rochester School of Medicine, New York 14642, USA.
Kirton
O
O
Windsor
J
J
Hudson-Civetta
J
J
Lynn
M
M
Herman
M
M
Civetta
J
J
D018806:APACHE; D000138:Acidosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000975:Antioxidants / Q000627:therapeutic use*; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016638:Critical Illness; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D005492:Folic Acid / Q000627:therapeutic use*; D005745:Gastric Acidity Determination; D005753:Gastric Mucosa / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007545:Isoproterenol / Q000627:therapeutic use; D008353:Mannitol / Q000627:therapeutic use; D009102:Multiple Organ Failure / Q000517:prevention & control; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications* / Q000401:mortality / Q000503:physiopathology
D000975:Antioxidants; D002316:Cardiotonic Agents; D004234:Diuretics, Osmotic; D014665:Vasodilator Agents; D008353:Mannitol; D004280:Dobutamine; D005492:Folic Acid; D007545:Isoproterenol