Comparison of gastric mucosal pH and clinical judgement in critically ill patients.
OBJECTIVE
To compare gastric tonometry (pHi) with estimates of pHi in ill injured patients, and to correlate pHi with haemodynamic variables.


METHODS
Prospective, non-interventional study.


METHODS
ICU of Level I trauma centre, USA.


METHODS
154 gastric tonometry measurements were compared with physicians' estimates of adequacy of resuscitation. Resuscitation was categorised as inadequate (pHi < 7.35) or adequate (pHi> or = 7.35). Measured and estimated pHi were also compared with oxygen delivery, oxygen consumption, cardiac index, mixed venous O2 saturation, and critical illness scores.


RESULTS
Estimated pHi was often higher than measured pHi in the judgement of all four surgical intensive care physicians. Measured pHi correlated positively with mixed venous O2 tension (r = 0.21). There were significant negative correlations between measured pHi and both oxygen delivery (r = -0.25) and oxygen consumption (r = 0.28). Estimated pHi correlated positively with mean arterial pressure (r = 0.21) and hospital day (r = 0.26); it correlated negatively with pulmonary arterial elastance (r = -0.35).


CONCLUSIONS
Experienced intensive care physicians tended to overestimate visceral perfusion, which suggests that gastric tonometry adds useful information over and above routine haemodynamic indices. Arterial blood pressure and mixed venous oxygen saturation correlated better with measured pHi than with other indices of perfusion.
Santoso
J T
JT
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, USA.
Wisner
D H
DH
Battistella
F D
FD
Owings
J T
JT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D016638:Critical Illness; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood / Q000378:metabolism; D010101:Oxygen Consumption; D010196:Pancreatic Elastase / Q000097:blood; D011446:Prospective Studies; D012151:Resuscitation
D010196:Pancreatic Elastase; D010100:Oxygen