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Related Experiment Videos

Is endotoxin and cytokine release related to a decrease in gastric intramucosal pH after hemorrhagic shock?

C Charpentier1, G Audibert, B Dousset

  • 1Department of Anesthesia and Surgical Intensive Care, Hôpital Central, Nancy, France.

Intensive Care Medicine
|January 4, 1998
PubMed
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In severe hemorrhagic shock, gut endotoxin release was common but not linked to outcome or gut ischemia markers. Lactate levels were more predictive of patient survival than gastric intramucosal pH (pHi) or mucosal-arterial carbon dioxide difference (PCO2-gap).

Area of Science:

  • Critical Care Medicine
  • Gastroenterology
  • Trauma Surgery

Background:

  • Severe hemorrhagic shock can lead to gut ischemia and potential endotoxin release.
  • Gut ischemia markers like gastric intramucosal pH (pHi) and mucosal-arterial carbon dioxide difference (PCO2-gap) may reflect mucosal injury.
  • Endotoxins and cytokines (TNF-alpha, IL-6) are implicated in the inflammatory response to shock.

Purpose of the Study:

  • To investigate the relationship between gut ischemia parameters (pHi, PCO2-gap) and endotoxin/cytokine release during hemorrhagic shock.
  • To compare the predictive value of pHi, PCO2-gap, and arterial lactate for patient outcomes.

Main Methods:

  • Prospective study involving 20 multiple trauma patients with severe hemorrhagic shock.
  • Intramucosal measurements (pHi, PCO2-gap) and blood samples were collected over 48 hours.

Related Experiment Videos

  • Measured endotoxin, tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) levels.

    • Main Results:

    • Endotoxin was detected in all patients, regardless of outcome, and was not correlated with pHi or PCO2-gap.
    • Elevated IL-6 levels were associated with low pHi or high PCO2-gap, but not predictive of outcome.
    • TNF-alpha levels were higher in non-survivors after 24 hours.
    • Arterial lactate concentrations were predictive of outcome from 12 hours onwards.

    Conclusions:

    • Gut endotoxin translocation is common in severe hemorrhagic shock but appears independent of pHi and patient outcome.
    • Neither pHi nor PCO2-gap provided additional prognostic information beyond lactate measurements.
    • Lactate concentration is a more reliable predictor of outcome in severe hemorrhagic shock compared to gut ischemia markers.