A PROSPECTIVE RANDOMIZED STUDY OF END-POINTS OF RESUSCITATION AFTER MAJOR TRAUMA - GLOBAL OXYGEN-TRANSPORT INDEXES VERSUS ORGAN-SPECIFIC GASTRIC-MUCOSAL PH

BACKGROUND: Gastric tonometry, as a method of organ-specific monitorin g of the status of the splanchnic circulation, has demonstrated progno stic and therapeutic implications in critically ill patients. The expe rience with this method in patients with trauma has been limited. STUD Y DESIGN: Fifty-seven patients were prospectively randomized into two groups: group 1, n=30, normalization and maintenance of gastric mucosa l pH (pHi) at or above 7.3 and group 2, n=27, maintenance of oxygen de livery index of 600 or an oxygen consumption index of greater than 150 . The groups had statistically similar injury severity scores, lactate levels, and base deficits. RESULTS: Of the 44 patients with pHi great er than 7.3 at 24 hours, three (6.8 percent) died of multiple organ dy sfunction syndrome as compared with seven (53.9 percent) of 13 in whom pHi was not optimized, p=0.006. Optimization times for oxygen deliver y index, oxygen consumption index, lactate levels, and base excess wer e similar between survivors and nonsurvivors. The time for pHi optimiz ation was significantly longer in nonsurvivors. Multiple organ dysfunc tion syndrome points were significantly higher in patients who did not have pHi optimized within 24 hours (6.08 compared with 2.5, p=0.03). Optimization time for pHi was predictive of mortality on multiple regr ession. Persistently low pHi was frequently associated with systemic o r intra-abdominal complications. It was the first finding in all the n onsurvivors at least 48 to 72 hours before death. CONCLUSIONS: Gastric mucosal pH may be an important marker to assess the adequacy of resus citation.