Splanchnic hypoperfusion-directed therapies in trauma: a prospective, randomized trial.
Splanchnic hypoperfusion as reflected by gastric intramucosal acidosis has been recognized as an important determinant of outcome in shock. A comprehensive splanchnic hypoperfusion-ischemia reperfusion (IRP) protocol was evaluated against conventional shock management protocols in critical trauma patients. The study was a prospective randomized trial comparing three therapeutic approaches to hypoperfusion after severe trauma in 151 trauma patients admitted to the intensive care unit. Group 1 patients received hemodynamic support based on conventional indicators of hypoperfusion. In group 2, resuscitation was further guided by gastric tonometry-derived estimates of splanchnic hypoperfusion and included more invasive hemodynamic monitoring and additional administration of colloid or crystalloid solutions, or inotropic support. Group 3 patients additionally received therapies specifically aimed at. optimizing splanchnic perfusion and minimizing oxidant-mediated damage from reperfusion. The three groups were similar based on age, Injury Severity Score, and Acute Physiology and Chronic Health Evaluation II Scores. There were no statistically significant differences in mortality rates, organ dysfunction, ventilator days, or length of stay between any of the interventions. Techniques of optimization of splanchnic perfusion and minimization of oxidant-mediated reperfusion injury evaluated in this study were not advantageous relative to standard resuscitation measures guided by conventional or tonometric measures of hypoperfusion in the therapy of occult and clinical shock in trauma patients.
D018806:APACHE; D000368:Aged; D003422:Critical Care; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D005745:Gastric Acidity Determination; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015601:Injury Severity Score; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000517:prevention & control; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010477:Perfusion / Q000379:methods*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012151:Resuscitation / Q000379:methods*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012769:Shock / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013152:Splanchnic Circulation / Q000502:physiology*; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome