Introduction
The aim of this prospective non intervention study is to evaluate if the analysis of some perfusional indexes, as gastric intramucosal pH (pHi, U and plasma disappearance rate of indocyanine green (PDR dye, %/min), may be useful for prognostic evaluation in patients with MODS.
Material and methods
Eighty-four medical or surgical patients, with MODS (mean age 51, SD 17; mean SAPS II (1st day) 56, SD 9), were studied. After 6 h of ICU stay, a gastric tonometer, a 7.5 pulmonary artery catheter and a 4 F femoral artery catheter were inserted. The vascular catheters were connected to `COLD System', an integrated monitoring system which uses the double indicator technique and studies hepatic perfusion, by analysis of PDR. All patients were in CMV and received ranitidine. The haemodynamic management was realized in order to optimize cardiac output (CO2 l/min/m2 BS) and systemic oxygen delivery (DO2, ml/min/m2 BS). All data were recorded at the beginning of the study (T0) and after 6 (T1), 12 (T2), 24 (T3) and 36 (T4) hours. Statistical analysis of data was performed using Manova Test, considering the significant differences in the times of study between survivors (S) and non-survivors (NS) and analysing the variance of repeated measures. Levels of P < 0.05 were accepted.
Results and conclusions
40 (47.6%) patients died. Some data are shown in the Table (as mean and (SD); S vs NS: *P < 0.0001;$P < 0.005; T vs TO:§>P < 0.05).
In this group of patients, a precocious splanchnic hypoperfusion seems to be the main prognostic factor. In NS group, gastric intramucosal acidosis is present in the early period of study and it is possible to notice a continuous worsening of liver perfusion. According to this point of view, perfusional parameters may give more prognostic informations than systemic data.
Table.
| Time 0 | Time 1 | Time 2 | Time 3 | Time 4 | |
|---|---|---|---|---|---|
| CO | S 4.5 (1.5) | 5 (1.6) | (1.6) | (1.6) | 5 (1.5) |
| NS 4.7 (1.9) | 4.6 (1.9) | 4.9 (2.1) | 5 (2.3) | 4.6 (1.7) | |
| DO2 | S 656 (202) | 723 (219) | 713 (186) | 672 (199) | 697 (207) |
| NS 631 (273) | 628 (274) | 670 (288) | 679 (351) | 614(228) | |
| PHi* | S 7.45 (0.07) | 7.41 (0.09) | 7.39 (0.14) | 7.40 (0.13) | 7.41 (0.1) |
| NS 7.32 (0.1) | 7.29 (0.21) | 7.25 (0.24)§ | 7.24 (0.19)§ | 7.25 (0.18)§ | |
| PDR$ | S 13.3 (6) | 13.1 (7.2) | 13.4 (6.2) | 13.3 (6.3) | 13.8 (6.8) |
| NS 9.2 (6.1) | 8.9 (5.5) | 8.7 (4.8) | 8.5 (4.2) | 8.6 (5.7) |