Gastric tonometry after subarachnoid hemorrhage.
OBJECTIVE
To evaluate splanchnic tissue perfusion, assessed by gastric tonometry, in patients with subarachnoid hemorrhage (SAH) and to study the effect of treatment, either surgical or endovascular, and the severity of initial SAH on splanchnic tissue perfusion.


METHODS
Prospective observational substudy, part of a randomised controlled trial of early treatment of ruptured intracranial aneurysms.


METHODS
Intensive care unit (ICU) of a university hospital.


METHODS
A consecutive sample of 26 patients [13 surgical (7/6 Hunt & Hess Grade I-II/H & H Gr IV-V) and 13 endovascular (3/10 H & H Gr I-II/H & H Gr IV-V)] out of 56 SAH patients randomly assigned to either endovascular or surgical treatment during the substudy period between 1 May 1995 and 31 August 1996. All patients were treated within 72 h after SAH.


RESULTS
After treatment of a ruptured aneurysm, hemodynamics and gastric intramucosal pCO2 were measured during the first 4 h and between 6 h and 12 h after aneurysm treatment. In the whole sample, neither the gastric intramucosal-arterial pCO2 difference (pCO2 gap) (1.5+/-1.9 kPa and 1.7+/-1.2 kPa, NS) nor gastric intramucosal pH (7.28+/-0.12 and 7.29+/-0.08, NS) changed during the study. There were no differences in pCO2 gap or gastric intramucosal pH between treatment groups or Hunt & Hess grade groups during the study period.


CONCLUSIONS
Splanchnic tissue perfusion may be insufficient even though there is no systemic hemodynamic disturbance in patients after SAH. Neither the therapeutic treatment nor pre-treatment Hunt & Hess grade is associated with a specific pattern of pCO2 gap.
Koivisto
T
T
Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, SF-70211 Kuopio, Finland. timo.koivisto@kuh.fi
Vapalahti
M
M
Parviainen
I
I
Takala
J
J
D000368:Aged; D017130:Angioplasty; D001784:Blood Gas Analysis / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D003422:Critical Care / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply* / Q000378:metabolism*; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology*; D013152:Splanchnic Circulation; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome