Introduction: Low mucosal lonoroetric pH has been shown to be highly predictive of mortality in general and trauma ICU patients. Methods: Prospective 3 month study of critically injured blunt and penetrating admissions to a Level 1 Trauma ICU. Hemodynamk optimization was based on achieving pHi > 7.25, including the use of splanchnic-sparing vasopressors (e.g., dobutamine, dopamine, etc.). All patients received intravenous doses of mannitol, folate, Iklocaine, vitamin C. selenium, polymyxin B and hydrocortisone, [n addition. Vitamin A and E phis glutamine and N-acetylcysteine were given by enterai route. If pHi became abnormal (Abn-pHi <725) post-normalization (Nonn-pHi;>7.25), the episode(s) was characterized as a fluctuation (Flue). Data was analyzed by Cht-square. Results: 92 patients : (mearttSD) Trauma Score -14±2, ISS- 2716; CCS -13±3; APACHE II- I9±8. pHi Group Lived Died % Lived Cfci-Sq TVn.lPt. Q->A f. QjH EadNonn 87 84 3 97% g-H Ah 5 2 3 Start Abo 16 12 4 75V. St.rt Nnrm 76 74 > Always Nora 58 58 0 100% Always Aba 2 1 1 50% Ab_->nM-Norai 29 26 3 90% isiii->irii_2 2 2 054 < AbaAaytime 34 28 6 82% End Aba 523 40% End Norm 29 26 3 90% < .0399 14 of 16 abnormal pHi (88%) on admission normalized with the protocol. In this subset, overall mortality of normalized pHi was 3% (p<.001), compared to a 60% mortality in those patients with uncorrectable pHi (p<.001). Conclosion: Normalization of pHi using a pHi-driven protocol and administering agents to prevent and scavenge oxygen free-radicals in the critically-ill injured is associated with high survival.
|Original language||English (US)|
|Journal||Critical care medicine|
|Issue number||1 SUPPL.|
|State||Published - Dec 1 1998|
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine