Intestinal and gastric tonometry during experimental burn shock

Area of Science:

• Critical Care Medicine
• Surgical Research
• Physiology

Background:

• Organ failure post-thermal injury necessitates improved end-organ perfusion monitoring.
• Gastrointestinal (GI) tonometry is explored as a method to assess perfusion during burn shock.
• Current resuscitation strategies aim to restore hemodynamic parameters and urine output.

Purpose of the Study:

• To evaluate the clinical utility of GI tonometry in monitoring end-organ perfusion.
• To compare gastric versus ileal tonometry during burn shock and resuscitation.
• To assess the effectiveness of tonometry in guiding resuscitation efforts.

Main Methods:

• Male swine (n=11) underwent a 70% full-thickness burn.
• Resuscitation initiated at 6 hours with lactated Ringer's, titrated to urine output.
• Continuous gastric and ileal regional PCO2 (PrCO2) measured by air tonometry.
• Intramucosal pH (pHi) and PCO2 gap calculated every 6 hours.

Main Results:

• Gastric pHi, ileal PrCO2, ileal pHi, and ileal PCO2 gap decreased during shock.
• These parameters returned to baseline with resuscitation.
• Ileal tonometry showed greater magnitude and less variability in changes compared to gastric tonometry.

Conclusions:

• Ileal tonometry demonstrated superior performance over gastric tonometry in this burn shock model.
• Ileal tonometry may be a more reliable indicator of end-organ perfusion during burn resuscitation.
• Further research is warranted to validate these findings in clinical settings.