Gastric tonometry versus cardiac index as resuscitation goals in septic shock: A multicenter, randomized, controlled trial

Introduction: Resuscitation goals for septic shock remain controversial. Despite the normalization of systemic hemodynamic variables, tissue hypoperfusion can still persist. Indeed, lactate or oxygen venous saturation may be difficult to interpret. Our hypothesis was that a gastric intramucosal pH-g...

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Autores principales: Palizas, Fernando, Dubin, Arnaldo, Regueira, Tomas, Bruhn, Alejandro, Knobel, Elias, Lazzeri, Silvio, Baredes, Natalio, Hernández, Glenn
Formato: Articulo
Lenguaje:Inglés
Publicado: 2009
Materias:
Ciencias Médicas
septic shock remain
pHguided resuscitation protocol
Acceso en línea:http://sedici.unlp.edu.ar/handle/10915/82735
Aporte de:
SEDICI (UNLP) de Universidad Nacional de La Plata
id I19-R120-10915-82735
record_format dspace
institution Universidad Nacional de La Plata
institution_str I-19
repository_str R-120
collection SEDICI (UNLP)
language Inglés
topic Ciencias Médicas
septic shock remain
pHguided resuscitation protocol
spellingShingle Ciencias Médicas
septic shock remain
pHguided resuscitation protocol
Palizas, Fernando
Dubin, Arnaldo
Regueira, Tomas
Bruhn, Alejandro
Knobel, Elias
Lazzeri, Silvio
Baredes, Natalio
Hernández, Glenn
Gastric tonometry versus cardiac index as resuscitation goals in septic shock: A multicenter, randomized, controlled trial
topic_facet Ciencias Médicas
septic shock remain
pHguided resuscitation protocol
description Introduction: Resuscitation goals for septic shock remain controversial. Despite the normalization of systemic hemodynamic variables, tissue hypoperfusion can still persist. Indeed, lactate or oxygen venous saturation may be difficult to interpret. Our hypothesis was that a gastric intramucosal pH-guided resuscitation protocol might improve the outcome of septic shock compared with a standard approach aimed at normalizing systemic parameters such as cardiac index (CI). Methods: The 130 septic-shock patients were randomized to two different resuscitation goals: CI ≥ 3.0 L/min/m2 (CI group: 66 patients) or intramucosal pH (pHi) ≥ 7.32 (pHi group: 64 patients). After correcting basic physiologic parameters, additional resuscitation consisting of more fluids and dobutamine was started if specific goals for each group had not been reached. Several clinical data were registered at baseline and during evolution. Hemodynamic data and pHi values were registered every 6 hours during the protocol. Primary end point was 28 days' mortality. Results: Both groups were comparable at baseline. The most frequent sources of infection were abdominal sepsis and pneumonia. Twenty-eight day mortality (30.3 vs. 28.1%), peak Therapeutic Intervention Scoring System scores (32.6 ± 6.5 vs. 33.2 ± 4.7) and ICU length of stay (12.6 ± 8.2 vs. 16 ± 12.4 days) were comparable. A higher proportion of patients exhibited values below the specific target at baseline in the pHi group compared with the CI group (50% vs. 10.9%; P < 0.001). Of 32 patients with a pHi < 7.32 at baseline, only 7 (22%) normalized this parameter after resuscitation. Areas under the receiver operator characteristic curves to predict mortality at baseline, and at 24 and 48 hours were 0.55, 0.61, and 0.47, and 0.70, 0.90, and 0.75, for CI and pHi, respectively. Conclusions: Our study failed to demonstrate any survival benefit of using pHi compared with CI as resuscitation goal in septic-shock patients. Nevertheless, a normalization of pHi within 24 hours of resuscitation is a strong signal of therapeutic success, and in contrast, a persistent low pHi despite treatment is associated with a very bad prognosis in septic-shock patients.
format Articulo
Articulo
author Palizas, Fernando
Dubin, Arnaldo
Regueira, Tomas
Bruhn, Alejandro
Knobel, Elias
Lazzeri, Silvio
Baredes, Natalio
Hernández, Glenn
author_facet Palizas, Fernando
Dubin, Arnaldo
Regueira, Tomas
Bruhn, Alejandro
Knobel, Elias
Lazzeri, Silvio
Baredes, Natalio
Hernández, Glenn
author_sort Palizas, Fernando
title Gastric tonometry versus cardiac index as resuscitation goals in septic shock: A multicenter, randomized, controlled trial
title_short Gastric tonometry versus cardiac index as resuscitation goals in septic shock: A multicenter, randomized, controlled trial
title_full Gastric tonometry versus cardiac index as resuscitation goals in septic shock: A multicenter, randomized, controlled trial
title_fullStr Gastric tonometry versus cardiac index as resuscitation goals in septic shock: A multicenter, randomized, controlled trial
title_full_unstemmed Gastric tonometry versus cardiac index as resuscitation goals in septic shock: A multicenter, randomized, controlled trial
title_sort gastric tonometry versus cardiac index as resuscitation goals in septic shock: a multicenter, randomized, controlled trial
publishDate 2009
url http://sedici.unlp.edu.ar/handle/10915/82735
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