Intramucosal pH measurement with tonometers for detecting gastrointestinal ischemia in critically ill patients

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To clarify an availability of gastric tonometer as a moniter for adequacy of tissue oxygenation in the splanchnic organs, intramucosal pH (pHi) was measured in 38 critically ill patients with multiple trauma (10), burn (5), major surgery (18) and sepsis (5). The results were as follows ;1.The value of pHi was reduced to less than 7.3 at the compansated state from shock or at the immediate postoperative period, but most patients recovered to the level of 7.3 or more within the first 72 hours postinjury. The pHi value in two cases persisted less than 7.3 over 72 hours postinjury with fatal outcome.2.Significant correlations were observed among pHi and lactate, IL-6, arterial keton body ratio, nutrophil elastase and plasminogen activator inhibitor-1 in 15 patients with trauma shock after the first 72 hours postinjury. A close relationship was admitted between the degree of insult and the value of pHi.3.The value of pHi was reduced despite of supranormalisation of Do2 and adequate Vo2 calculated with Swan-Ganz catheter. The adequacy of mucosal oxygenation in hyperdymamic state of patients was not assessed with the conventional method, therefore, measuring intramucosal pH in the stomach is a new predictor of development of mesenteric hypoperfusion.4.To overcome the inadequacy of tissue oxygenation, the effect of the vasodilators such as Dopamine or PGE1 were tested and the latter was effective on improving of the pHi value.5.A significant correlation was seen between pH of gastric juice and the value of pHi, therefore, the administration of a histamine-2 receptor antagonist may be required to get the reproducibility of pHi.The results of this study indicated that measurements of intramucosal pH provide a metabolic measure of the adequacy of tissue oxygenation in the postoperative or postinjury phase as well as in septic patients.Further studies are needed to eludcidate the mechanism about how oxygen extraction rate can be improved in mucosal metahbolism.