[Gastric mucosa tonometry in routine monitoring in the surgical intensive care unit]

Monitoring tissue oxygenation in the splanchnic region could be helpful for critically ill patients. In this study the postoperative course of gastric mucosal CO2 (prCO2) in 40 patients is shown.

Following approval of the ethics committee, 24 patients schedulded for surgery with an expected large fluid turnover and 16 multiple injured patients were monitored with a gas tonometry device in addition to standard monitoring (ECG, pulse oximetry, capnometry, CVP, arterial pressure). Normoventilated patients with prCO2 > 50 for more than 30 minutes were treated with fluid therapy, followed by catecholamine therapy, followed by transfusion (fig. 1). All patients were admitted to the SICU post-operatively.

The variation of prCO2-values was greater in multiple injured patients. Their prCO2-values began in a lower range compared to patients with scheduled operation, became higher at the end of the first SICU-day and remained higher thereafter. They had a higher fluid turnover and needed more catecholamines. Multiple injured patients with an arterio-intestinal CO2-Difference (CO2-Gap) > 10 had a higher ISS-Score, were longer mechanically ventilated, had a longer SICU-stay and a higher incidence of complications in comparison to patients with aCO2-Gap < 10. Perhaps a CO2-Gap > 10 could be predictive for a more severe course in intensive care patients.