Document Detail


Does splanchnic ischemia occur in isolated neurotrauma? A prospective observational study.
MedLine Citation:
PMID:  10397225     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To characterize the incidence and severity of splanchnic ischemia, as defined by gastric tonometry, in patients with isolated severe head injury and to examine the relationship between cerebral hemodynamics and splanchnic ischemia. DESIGN: Prospective observational study. SETTING: Neurosurgical intensive care unit in a tertiary referral center. PATIENTS: Ten patients with severe neurotrauma. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The mean arterial pressure, intracranial pressure, and gastric mucosal P(CO2) measurements were recorded at 15-min intervals. Intramucosal pH was calculated every 3 hrs. All patients received stress ulcer prophylaxis. Nine patients received noradrenaline infusions to maintain a target cerebral perfusion pressure of 70 mm Hg. The mean baseline gastric mucosal P(CO2) and intramucosal pH were 38+/-10 torr and 7.38+/-0.1 pH units, respectively. Nine patients manifested low intramucosal pH during the study period. Gastric mucosal P(CO2) values ranged from 36 to 132 torr. Intramucosal pH measurements ranged from 6.9 to 7.47. The mucosal gap ranged from -12 to +93 torr (mean +/- SD, 17+/-17 torr). The pH gap ranged from -0.1 to +0.54 pH units (mean +/- SD, 0.14+/-0.11 pH units). There was no statistically significant relationship between cerebral hemodynamics, the use of inotropes, and gastric mucosal P(CO2), or intramucosal pH. CONCLUSIONS: Splanchnic ischemia (intramucosal pH, <7.3) occurs commonly in isolated neurotrauma, with a statistically nonsignificant trend toward development of mucosal ischemia with decreased cerebral perfusion.
Authors:
B Venkatesh; S Townsend; R J Boots
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  27     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-08-05     Completed Date:  1999-08-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1175-80     Citation Subset:  AIM; IM    
Affiliation:
Royal Brisbane Hospital, University of Queensland, Herston, Australia.
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MeSH Terms
Descriptor/Qualifier:
Acidosis / etiology
Adolescent
Adult
Cerebrovascular Circulation
Craniocerebral Trauma / complications*,  physiopathology
Critical Care
Female
Gastric Mucosa / blood supply*,  physiopathology
Hemodynamics
Humans
Hydrogen-Ion Concentration
Injury Severity Score
Intraocular Pressure
Ischemia / etiology*
Male
Norepinephrine / administration & dosage
Prospective Studies
Splanchnic Circulation
Sympathomimetics / administration & dosage
Chemical
Reg. No./Substance:
0/Sympathomimetics; 51-41-2/Norepinephrine

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