Gastric intramucosal pH in the assessment of adequacy of resuscitation after trauma

Abstract

Gastric tonometry allows detection of abnormalities of metabolism that cause an elevated pCO2, such as tissue dysoxia or shock states. This may allow greater sensitivity in detecting insufficient resuscitation from known shock states, such as hypovolemic shock, or earlier detection of occult shock states, such as sepsis. This approach has been validated in several patient populations including hypovolemic trauma patients. There remains a population, however, in which the gastric intramucosal pCO2 can not be normalized by increases in global oxygen delivery. This may be due to ischemia-reperfu-sion injury. We developed a resuscitation algorithm to limit both hypovolemia or dysoxia and reperfusion injury. We postulate that a more aggressive approach to limiting reperfusion injury will allow further advances in decreasing morbidity and mortality of the critically injured trauma patient.