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Titolo:
Gastric tonometry in patients with cardiogenic shock and intra-aortic balloon counterpulsation
Autore:
Janssens, U; Graf, J; Koch, KC; vom Dahl, J; Hanrath, P;
Indirizzi:
Univ Aachen, Med Clin 1, D-5100 Aachen, Germany Univ Aachen Aachen Germany D-5100 en, Med Clin 1, D-5100 Aachen, Germany
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 10, volume: 28, anno: 2000,
pagine: 3449 - 3455
SICI:
0090-3493(200010)28:10<3449:GTIPWC>2.0.ZU;2-S
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; INTRAMUCOSAL PH; CARDIAC-OUTPUT; BLOOD-FLOW; MUCOSAL PH; ENDOTHELIN-1; VASOPRESSIN; ANGIOTENSIN; OXYGENATION; HEMORRHAGE;
Keywords:
gastrotonometry; gastric intramucosal pH; microcirculation; cardiogenic shock; intra-aortic balloon pumping; counterpulsation; outcome; mortality; critical illness; monitoring;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Janssens, U Univ Aachen, Med Clin 1, D-5100 Aachen, Germany Univ Aachen Aachen Germany D-5100 1, D-5100 Aachen, Germany
Citazione:
U. Janssens et al., "Gastric tonometry in patients with cardiogenic shock and intra-aortic balloon counterpulsation", CRIT CARE M, 28(10), 2000, pp. 3449-3455

Abstract

Objective: To study the course of gastric regional PCO2 (PrCO2) in patients with cardiogenic shock requiring intra-aortic balloon (IAB) counterpulsation and the prognostic value of PrCO2 in this patient population. Design:A prospective, observational clinical study. Setting: Medical intensive care unit in a university hospital. Patients: Twenty-six consecutive patients with cardiogenic shack requiringmechanical support with an IAB counterpulsation undergoing mechanical ventilationInterventions: None. Measurements and Main Result. Hemodynamic variables, tonometric variables,arterial blood gases, and arterial lactate were assessed before insertion of IAB (baseline), and 1, 2, 3, 8, 16, 24, and 48 hrs thereafter. A subset of these patients (n = 14) were studied just before and 1, 8, 24, and 32 hrs after IAB removal; 12/26 patients (46.2%) died. Cardiac index increased from baseline to 1 hr after insertion of IAB (1.7 +/- 0.3 to 2.6 +/- 0.8 L/min/m(2), p < .05), PrCO2 did not change between admission (47 +/- 13 torr [6.3 +/- 1.7 kPa]) and 8 hrs after placement of IAB but increased to 63 +/- 22 torr (8.4 +/- 2.9 kPa) at 16 hrs (p < .05) without any further alteration until 48 hrs. CO2 gap showed a similar pattern with 15 +/- II torr (2.0 +/- 1.5 kPa) at baseline and an increase to 28 +/- 22 torr (3.7 +/- 2.9 kPa)16 hrs later. PrCO2 and CO2 gap remained at high levels (59 +/- 11 torr [7.7 +/- 1.5 kPa] and 22 +/- 10 torr [2.9 +/- 1.3 kPa], respectively), beforeIAB removal without further improvement or deterioration thereafter. PrCO2,values showed no difference between survivors and nonsurvivors at any timepoint. Conclusion: Patients with cardiogenic shock developed high PrCO2 within the first 24 hrs, which reflects gastric mucosal ischemia. Persistently high levels of PrCO2 were indicative for prolonged hypoperfusion of the gut Gastric tonometry failed to discriminate between survivors and nonsurvivors.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/01/20 alle ore 00:28:35