Abstract
Introduction The occurrence of organ failure following thermal injury, despite restoration of hemodynamic parameters and urine output during resuscitation, has led to efforts to measure end-organ perfusion. The purpose of this 24-h study was to evaluate the utility of gastrointestinal (GI) tonometry during burn shock and resuscitation. Methods Male swine ( n = 11, 23.3 ± 0.9 kg) were anesthetized with ketamine and propofol. A 70% full thickness burn was caused by immersion in 97 °C water for 30 s. Resuscitation with lactated Ringer's, 4 ml/kg/% burn, was begun at hour 6 and titrated to urine output (UO). Arterial blood gases and pulmonary artery catheter data were measured every 6 h. Gastric and ileal regional PCO 2 (PrCO 2) were measured continuously by air tonometry, and the gastric and ileal intramucosal pH (pHi) and PCO 2 gap (PrCO 2 − PaCO 2) were calculated every 6 h. Results Gastric pHi, ileal PrCO 2, ileal pHi, and ileal PCO 2 gap (but not gastric PrCO 2 or PCO 2 gap) all decreased with shock and were restored to baseline levels by resuscitation. Changes in ileal PrCO 2 were of greater magnitude and demonstrated decreased variability than those in gastric PrCO 2. Conclusions In this model, ileal tonometry outperformed gastric tonometry during burn shock and resuscitation.
Published Version
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