Chest
Clinical Investigations in Critical CareIncreasing Splanchnic Blood Flow in the Critically III
Section snippets
Study Population
Twenty five critically ill patients admitted to the ICU of Guy's Hospital were studied (Table 1). They all met the criteria for the diagnosis of the “systemic inflammatory response syndrome”26 and required both mechanical ventilation for acute respiratory failure and pulmonary artery catheterization for adequate hemodynamic management. They were sedated with a continuous infusion of narcotic (papaveretum or fentanyl) in combination with a benzodiazepine (midazolam) and were fully resuscitated
Results
The demographic characteristics of the patients studied are shown in Table 1. Median age was 57 years (range, 19 to 78 years) and median first 24-h APACHE II score was 22 (range, 7 to 40). The ICU mortality rate for the 25 patients was 40%, and the standardized mortality ratio (actual hospital mortality: expected mortality) was 1.08. Both dopexamine and dopamine were well tolerated and there were no deleterious effects associated with administration of lidocaine or ICG. The three groups were
Discussion
Splanchnic ischemia (affecting both the GI tract and liver) seems to be a major factor determining outcome in critically ill patients,14,28, 29, 30, 311 and it appears that gastric tonometry and the MEGX test permit the early detection of this ischemia.14,31 A number of studies have demonstrated that a low intramucosal pH (intramucosal pH), as measured by gastric tonometry, indicates inadequate splanchnic oxygenation,3, 4, 5, 6, 7, 8, 9, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 2, 2, 2, 2, 2, 2, 2, 2, 2, 2
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Supported by a grant awarded by the Special Trustees of Guy's Hospital.