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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 6/2011

01-12-2011 | Original Article

Reliability of measurement techniques for the hepato-splanchnic region in multiple-trauma patients

Authors: D. Kljucevsek, L. Kompan

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2011

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Abstract

Purpose

Relevant information on the adequacy of intestinal perfusion is needed. The objective of our study was to investigate the relationship between the difference in intra-mucosal and arterial CO2 pressure (pCO2 gap) and the outcome in multiply injured patients and relations between the pCO2 gap and intestinal permeability (IP).

Methods

Forty consecutive multiply injured patients, admitted to the intensive care unit (ICU) of the University Medical Centre Ljubljana, were studied prospectively. On days 2 and 4, IP was measured using the lactulose–mannitol (L/M) test. For 4 days, the pCO2 gap was measured using air tonometry. Multiple organ failure (MOF) scores were calculated daily.

Results

No significant differences in the MOF scores and length of ICU stay were found between the groups formed with respect to the presumably normal pCO2 gap value of 1.33 kPa. The baseline pCO2 gap difference in patients with abdominal injuries was significantly (p = 0.01) higher in comparison with those without abdominal injuries. There was no correlation between the pCO2 gap values and L/M index measured simultaneously and also between the baseline and average pCO2 gap and L/M index measured on days 2 and 4. We were unable to find any association between the MOF score and pCO2 gap. The MOF score, however, correlated significantly with the L/M value determined on day 4 (r = 0.85, p = 0.02). The average gastric retention volume was inversely correlated with the average pCO2 gap (r = −0.33, p = 0.04).

Conclusions

The pCO2 gap in trauma patients on intra-gastric enteral nutrition in the phase of present technical solutions has no prognostic value for the development of MOF, but IP correlated with it.
Literature
1.
Moore FA, Moore EE. Evolving concepts in the pathogenesis of post injury multiple organ failure. Surg Clin North Am. 1995;75:257–77.PubMed
2.
Fiddian-Green RG, Baker S. Predictive value of the stomach wall pH for complications after cardiac operations: comparison with other monitoring. Crit Care Med. 1987;15:153–6.PubMedCrossRef
3.
Meisner FG, Habler OP, Kemming GI, Kleen MS, Pape A, Messmer K. Changes in piCO2 reflect splanchnic mucosal ischaemia more reliably than changes in pHi during haemorrhagic shock. Langenbecks Arch Surg. 2001;386:333–8.PubMedCrossRef
4.
Fink MP. Clinical tests of gastrointestinal permeability that rely on the urinary recovery of enterally administered probes can yield invalid results in critically ill patients. Intensive Care Med. 2002;28:103–4.PubMedCrossRef
5.
Sinclair DG, Haslam PL, Quinlan GJ, Pepper JR, Evans TW. The effect of cardiopulmonary bypass on intestinal and pulmonary endothelial permeability. Chest. 1995;108:718–24.PubMedCrossRef
6.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.PubMedCrossRef
7.
Seneff M, Knaus WA. APACHE: a prognostic scoring system. Probl Crit Care. 1989;3:563–78.
8.
Miller PR, Kincaid EH, Meredith JW, Chang MC. Threshold values of intramucosal pH and mucosal–arterial CO2 gap during shock resuscitation. J Trauma. 1998;45:868–72.PubMedCrossRef
9.
Pukl M, Prošek M. Rapid quantitative TLC analysis of sugars using an improved commonly used solvent system. J Planar Chromatogr. 1990;3:173–5.
10.
Goris RJA, te Boekhorst TP, Nuytinck JKS, Gimbrère JSF. Multiple-organ failure. Generalized autodestructive inflammation? Arch Surg. 1985;120:1109–15.PubMedCrossRef
11.
Doglio GR, Pusajo JF, Egurrola MA, Bonfigli GC, Parra C, Vetere L, et al. Gastric mucosal pH as a prognostic index of mortality in critically ill patients. Crit Care Med. 1991;19:1037–40.PubMedCrossRef
12.
Gomersall CD, Joynt GM, Freebairn RC, Hung V, Buckley TA, Oh TE. Resuscitation of critically ill patients based on the results of gastric tonometry: a prospective, randomized, controlled trial. Crit Care Med. 2000;28:607–14.PubMedCrossRef
13.
Levy B, Gawalkiewicz P, Vallet B, Briancon S, Nace L, Bollaert PE. Gastric capnometry with air-automated tonometry predicts outcome in critically ill patients. Crit Care Med. 2003;31:474–80.PubMedCrossRef
14.
Palizas F, Dubin A, Regueira T, Bruhn A, Knobel E, Lazzeri S, et al. Gastric tonometry versus cardiac index as resuscitation goals in septic shock: a multicenter, randomized, controlled trial. Crit Care. 2009;13:R44.PubMedCrossRef
15.
Kompan L, Kompan D. Importance of increased intestinal permeability after multiple injuries. Eur J Surg. 2001;167:570–4.PubMedCrossRef
16.
Riddington DW, Venkatesh B, Boivin CM, Bonser RS, Elliott TS, Marshall T, et al. Intestinal permeability, gastric intramucosal pH, and systemic endotoxemia in patients undergoing cardiopulmonary bypass. JAMA. 1996;275:1007–12.PubMedCrossRef
17.
Kolkman JJ, Groeneveld ABJ, Meuwissen SGM. Effect of gastric feeding on intragastric pCO2 tonometry in healthy volunteers. J Crit Care. 1999;14:134–8.
18.
Marshall AP, West SH. Gastric tonometry and enteral nutrition: a possible conflict in critical care nursing practice. Am J Crit Care. 2003;12:349–56.PubMed
19.
de Haan JJ, Lubbers T, Derikx JP, Relja B, Henrich D, Greve JW, et al. Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study. Crit Care. 2009;13:R86.PubMed
20.
Evennett NJ, Petrov MS, Mittal A, Windsor JA. Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia. World J Surg. 2009;33:1374–83.PubMedCrossRef
Metadata
Title
Reliability of measurement techniques for the hepato-splanchnic region in multiple-trauma patients
Authors
D. Kljucevsek
L. Kompan
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2011
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-010-0054-5

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