THE IMPLANT OF ANTIOXIDANT AND SPLANCHNIC-DIRECTED THERAPY ON PERSISTENT UNCORRECTED GASTRIC-MUCOSAL PH IN THE CRITICALLY INJURED TRAUMA PATIENT

Background: Critically ill trauma patients with gastric intramucosal a cidosis, as measured by gastric tonometry, have an increased incidence of multiple organ dysfunction syndrome despite supranormal O-2 delive ry, We altered our resuscitation protocol to maximize splanchnic blood flow and decrease oxygen-derived free radical damage, Design: Prospec tive clinical trial with historical controls, Methods: The protocol di ffered from control by including administration of folate, mannitol, a nd low-dose isoproterenol. All patients had gastric tonometers and pul monary artery catheters, If the intramucosal pH (pH(i)) was less than 7.25, splanchnic-sparing inotropic and vasodilatory agents were used t o optimize systemic cardiac output, Two groups of trauma patients with persistent intramucosal acidosis at 24 hours (pH(i) < 7.25) mere comp ared: a control group (n = 7), and patients who received the splanchni c/antioxidant protocol (n = 13).Results: The two groups were similar b ased on Acute Physiology and Chronic Health Evaluation II score, Injur y Severity Score, age, cardiac index, oxygen delivery, and oxygen cons umption, The ''splanchnic therapy'' group had fewer organ system failu res as well as shortened length of intensive care unit and hospital st ay, Three of 7 patients in the control group and 2 13 patients in the splanchnic therapy group had a final pHi < 7.25, Conclusion: Gastric t onometry-guided resuscitation and antioxidant/splanchnic therapy in cr itically ill trauma patients with persistent gastric mucosal acidosis may decrease multiple organ dysfunction syndrome.