Does splanchnic ischemia occur in isolated neurotrauma? A prospective observational study

Objective: To characterize the incidence and severity of splanchnic ischemi a, as defined by gastric tonometry, in patients with isolated severe head i njury and to examine the relationship between cerebral hemodynamics and spl anchnic ischemia, Design: Prospective observational study. Setting: Neurosurgical intensive care unit in a tertiary referral center. Patients: Ten patients with severe neurotrauma. Interventions: None. Measurements and Main Results: The mean arterial pressure, intracranial pre ssure, and gastric mucosal Pco(2) measurements were recorded at 15-min inte rvals. Intramucosal pH was calculated every 3 hrs. All patients received st ress ulcer prophylaxis. Nine patients received noradrenaline infusions to m aintain a target cerebral perfusion pressure of 70 mm Hg. The mean baseline gastric mucosal Pco(2) and intramucosal pH were 38 +/- 10 torr and 7.38 +/ - 0.1 pH units, respectively. Nine patients manifested low intramucosal pH during the study period. Gastric mucosal Pco(2) values ranged from 36 to 13 2 torr. Intramucosal pH measurements ranged from 6.9 to 7.47. The mucosal g ap ranged from -12 to +93 torr (mean +/- SD, 17 +/- 17 torr). The pH gap ra nged from -0.1 to +0.54 pH units (mean +/- SD, 0.14 +/- 0.11 pH units). The re was no statistically significant relationship between cerebral hemodynam ics, the use of inotropes, and gastric mucosal Pco(2), or intramucosal pH. Conclusions: Splanchnic ischemia (intramucosal pH, <7.3) occurs commonly in isolated neurotrauma, with a statistically nonsignificant trend toward dev elopment of mucosal ischemia with decreased cerebral perfusion.