title: Gastric tonometry guided therapy in critical care patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  The value of gastric intramucosal pH (pHi) can be calculated from the tonometrically measured partial pressure of carbon dioxide ([Formula: see text]) in the stomach and the arterial bicarbonate content. Low pHi and increase of the difference between gastric mucosal and arterial [Formula: see text] ([Formula: see text] gap) reflect splanchnic hypoperfusion and are good indicators of poor prognosis. Some randomized controlled trials (RCTs) were performed based on the theory that normalizing the low pHi or [Formula: see text] gap could improve the outcomes of critical care patients. However, the conclusions of these RCTs were divergent. Therefore, we performed a systematic review and meta-analysis to assess the effects of this goal directed therapy on patient outcome in Intensive Care Units (ICUs).
  
  
  METHODS
  We searched PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials comparing gastric tonometry guided therapy with control groups. Baseline characteristics of each included RCT were extracted and displayed in a table. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. Another measure of effect (risk difference, RD) was used to reassess the effects of gastric tonometry on total mortality. We performed sensitivity analysis for total mortality. Continuous outcomes were presented as standardised mean differences (SMDs) together with 95% CIs.
  
  
  RESULTS
  The gastric tonometry guided therapy significantly reduced total mortality (OR, 0.732; 95% CI, 0.536 to 0.999, P = 0.049; I(2) = 0%; RD, -0.056; 95% CI, -0.109 to -0.003, P = 0.038; I(2) = 0%) when compared with control groups. However, after excluding the patients with normal pHi on admission, the beneficial effects of this therapy did not exist (OR, 0.736; 95% CI 0.506 to 1.071, P = 0.109; I(2) = 0%). ICU length of stay, hospital length of stay and days intubated were not significantly improved by this therapy.
  
  
  CONCLUSIONS
  In critical care patients, gastric tonometry guided therapy can reduce total mortality. Patients with normal pHi on admission contributed to the ultimate result of this outcome; it may indicate that these patients may be more sensitive to this therapy.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. dr_xzhang@163.com.|Surgery Building, Union Hospital, No. 1277, Jiefang Road, Wuhan City, Hubei Province, 430022, China. dr_xzhang@163.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. muthaxw@163.com.|Surgery Building, Union Hospital, No. 1277, Jiefang Road, Wuhan City, Hubei Province, 430022, China. muthaxw@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Xuan
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan City, Hubei Province, 430030, China. ping_y2000@163.com.
authors.forename: Ping
authors.initials: P
authors.lastname: Yin
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. Linlinw.cool@163.com.|Surgery Building, Union Hospital, No. 1277, Jiefang Road, Wuhan City, Hubei Province, 430022, China. Linlinw.cool@163.com.
authors.forename: Linlin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. dr_xdwu@163.com.|Surgery Building, Union Hospital, No. 1277, Jiefang Road, Wuhan City, Hubei Province, 430022, China. dr_xdwu@163.com.
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. wqp1968@126.com.|Surgery Building, Union Hospital, No. 1277, Jiefang Road, Wuhan City, Hubei Province, 430022, China. wqp1968@126.com.
authors.forename: Qingping
authors.initials: Q
authors.lastname: Wu
mesh_terms: D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008365:Manometry / Q000379:methods / Q000706:statistics & numerical data*; D013272:Stomach Diseases / Q000175:diagnosis / Q000628:therapy*