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Gastric intramucosal pH in trauma patients: an index for organ failure risk?
A Toninelli1, C Agapiti, P Terenghi
1Cattedra di Anestesia e Rianimazione, Università degli Studi di Brescia.
Insights
Low gastric intramucosal pH (pHi) in trauma patients predicts organ failure. This early indicator, measured within 24 hours, helps identify patients at high risk for developing critical complications and adverse outcomes.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Gastroenterology
Background:
- Severe trauma often leads to systemic inflammatory response syndrome (SIRS), sepsis, and subsequent organ failure.
- Early identification of patients at risk for organ failure is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To determine if low gastric intramucosal pH (pHi) within the first 24 hours post-trauma can serve as an early risk index for organ failure.
- To investigate the predictive value of pHi for organ dysfunction in severe trauma patients.
Main Methods:
- A prospective clinical study was conducted in a general intensive care unit (ICU) of a university hospital.
- Thirty-one severe trauma patients (mean age 34.2 years) underwent gastric tonometer measurements to assess pHi within the initial 24 hours.
- Patient data including pHi, blood Base Excess, APACHE II, and Injury Severity Score (ISS) were analyzed in relation to sepsis, organ failure, and patient outcomes.
Main Results:
- All patients exhibited SIRS, with 45.2% developing sepsis and 22.6% experiencing organ failure.
- Patients who developed organ failure had significantly lower median pHi values (7.06) compared to those without organ failure (7.33) (p=0.02).
- Six patients (19.4%) died, primarily due to organ failure.
Conclusions:
- Low gastric intramucosal pH (pHi) measured within the first 24 hours after severe trauma appears to be a reliable early predictor of subsequent organ failure.
- This finding suggests that monitoring pHi could be a valuable tool in risk stratification and management of critically injured patients.
Objective:
To assess if low gastric intramucosal pH (pHi), in the first 24 hours from trauma, is an early risk index for organ failure in severe trauma.
Design:
Prospective clinical study.
Setting:
General ICU in a university hospital.
Patients:
Thirty-one consecutive trauma patients, aged 15 to 71 years (mean 34.2), 26 men and 5 women.
Measurements And Results:
In all patients pHi was measured using a gastric tonometer. All patients presented systemic inflammatory response syndrome (SIRS) and 14 patients (45.2%) developed sepsis. Seven patients developed one or more organ failures (22.6%). Six patients died (19.4%), five because of organ failure and one because of primary brain injury. The worst 12-24 hour pHi, the worst 24 hours blood Base Excess, APACHE II and ISS were grouped by absence or presence of sepsis, organ failure and by outcome. Patients developing organ failure had pHi values (median = 7.06) significantly lower than patients who did not developed organ failure (median = 7.33) (chi 2 = 5.35; p = 0.02).
Conclusions:
Our data suggest that low pHi during the first 24 hours from trauma seems to be a good predictor for the development of organ failure.