Resuscitation of critically ill patients based on the results of gastric tonometry: A prospective, randomized, controlled trial

Objective: To determine whether additional therapy aimed at correcting low gastric intramucosal pH (pHi) improves outcome in conventionally resuscitat ed, critically iii patients. Design: Prospective, randomized, controlled study. Setting: General intensive care unit (ICU) of a university teaching hospita l. Patients: A total of 210 adult patients, with a median Acute Physiology and Chronic Health Evaluation II score of 24 (range, 8-51). Interventions: All patients were resuscitated according to standard guideli nes. After resuscitation, those patients in the intervention group with a p Hi of <7.35 were treated with additional colloid and then dobutamine (5 mu g/kg/min then 10 mu g/kg/ min) until 24 hrs after enrollment. Measurements and Main Results: There were no significant differences (p >.0 5) in ICU mortality (39.6% in the central group vs. 38.5% in the interventi on group), hospital mortality (45.3% in the control group vs. 42.3% in the intervention group), and Ill-day mortality (43.7% in the control group vs. 40.2 in the intervention group); survival curves; median modified maximal m ultiorgan dysfunction score (10 points in the control group vs. 13 points i n the intervention group); median modified duration of ICU stay (12 days in the control group vs. 11.5 days in the intervention group); or median modi fied duration of hospital stay (60 days in the control group vs. 42 days in the intervention group). A subgroup analysis of those patients with gastri c mucosal pH of greater than or equal to 7.35 at admission revealed no diff erence in ICU mortality (10.3% in the control group vs. 14.8% in the interv ention group), hospital mortality (13.8% in the control group vs. 29.6% in the intervention group), or 30-day mortality (10.3% in the control group vs . 26.9% in the intervention group). Conclusions: The routine use of treatment titrated against pHi in the manag ement of critically ill patients cannot be supported. Failure to improve ou tcome may be caused by an inability to produce a clinically significant cha nge in pHi or because pHi is simply a marker of disease rather than a facto r in the pathogenesis of multiorgan failure.