Tonometry

Selected articles on Tonometry

FitzGerald JF, Fox SH, Civetta JM, Kirton OC, Hudson-Civetta JA
Strategies to prevent organ failure
Current Opinion in Anaesthesiology, No. 12:115-119, 1999
"The gastrointestinal tract is not any more considered to be a silent organ system, but strongly suspected to play a major role in the pathophysiology of MOSF. It has become the most common cause of death in the intensive care unit with mortality rates from 30 to 100% depending on the number of organ systems involved. Here the gut's involvement is explained with two hypothesis the gut being a motor or a starter of MOSF.

Therapies that restore adequate blood flow to the intestinal mucosa may reduce the incidence of MOSF."

Bennett-Guerrero E, Panah MH, Bodian CA, Methikalam BJ, Alfarone JR, DePerlo M, Mythen MG
Automated detection of gastric luminal partial pressure of carbon idoxide during cardiovascular surgery using Tonocap
Anesthesiology, No. 92:38 - 45, 2000
"High rate of cardiac surgical patients in US end up with prolonged hospital stay caused by organ dysfunction. Hypoperfusion of the gastrointestinal tract in surgical patients has been associated with adverse postoperative outcome and increased length of stay. The measurement of gastric PCO2 and calculation of gastric pHi with the Tonocap were predictive of postoperative complications."

Lebuffe G, Decoene C, Pol A, Prat A, Vallet B
Regional capnometry with air-automated tonometry detects circulatory failure earlier than conventional hemodynamics after cardiac surgery
Anesthesia Analgesia, Vol. 89, :1084 - 90, 1999
"It was found that systemic cardiovascular and oxygen variables are not reliable predictors of gastrointestinal hypoperfusion. Gastric tonometry can be used to identify patients having risk of circulatory failure after cardiopulmonary bypass earlier than with conventional variables.

Tonocap was used to measure gastric mucosal PCO2. Gastric-to-arterial CO2 gap, P(r-a)CO2 is an important marker of gastric mucosal hypoperfusion. The gap was larger in CF(Circulatory Failure) after cardiopulmonary bypass patients increasing during a 12-hr postbypass period and the only variable that differed between with and without groups."

Barquist E, Kirton O C, Civetta J M
Gastric intramucosal pH in the assessment of adequacy of resuscitation after trauma
Current Opinion in Critical Care, No. 4:259 - 262, 1998
"Gastric tonometry may be a more sensitive endpoint of resuscitation from traumatic hypovolemic shock and more accurate in predicting the risk of MODS than global measures of oxygen consumption and delivery.

Here the authors confirmed that failure of splanchnic resuscitation correlated wirth MODS and length of ICU stay in the hemodynamically unstable trauma patient."

Barquist E, Kirton O, Windsor J, Hudson-Civetta J, Lynn M, Herman M, Civetta J
The impact of antioxidant and slanchnic-directed therapy on persistent uncorrected gastric mucosal pH in the critically injured trauma patient
The Journal of Trauma, Vol. 44, No. 2 :355 - 360, 1998
"There was a significant reduction in the number of failed organ systems and a shorter ICU and hospital stay as a result of the "splanchnic" and antioxidant therapy guided by the gastric tonometer."

Miller P R, Kincaid E H, Meredith J W, Chang M C
Threshold values of intramucosal pH and mucosal-arterial CO2 gap during shock resuscitation
The Journal of Trauma, Vol. 45, No. 5:1868 - 872, 1998
"In this study 108 trauma patients had pHi and Gap values determined at 24 hours after intensive care unit admission. pHi less than 7.25 and Gap greater than 18 mmHg represent cutoffs that should be useful for evaluating the adequacy of intestinal perfusion during resuscitation."

Miller P R, Meredith J W, Chang M C
Randomized, prospective comparison of increased preload versus inotropes in the resuscitation of trauma patients: Effects on cardiopulmonary function and visceral perfusion
The Journal of Trauma, Vol. 44, No. 1:107 - 113, 1998
"This study shows that further increasing preload in trauma patients with low RVEF should be preferred over addition of inotropes with maintenance of normal RVEDVI because gut perfusion is better in the group with increased preload.
Gut perfusion was assessed by measuring gastric intramucosal pHi."

Kirton OC, Windsor J, Wedderburn R, Hudson-Civetta J, Shatz DV, Mataragas NR, Civetta JM
Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU
Chest, Vol. 113: 1064 - 69, 1998
"The findings in a number of studies have proved that achieving supranormal systemic oxygen delivery does not reliably confer improved outcome.

Gastric tonometry can be used noninvasively to monitor the adequacy of splanchnic perfusion. The superficial splanchnicus mucosa is extremely vulnerable to low blood flow, which is sacrificed first in shock.

Attainment of a pHi >= 7.32 at 24 hours reduced the likelihood of MOSF and length of stay among these critically ill, hemodynamically unstable trauma patients with signs of tissue hypoperfusion."

Kolkman JJ, Otte JA, Groeneveld ABJ
Gastrointestinal luminal P CO2 tonometry: an update on physiology, methodology and clinical applications
British Journal of Anaesthesia, Vol. 84, No. 1:74 - 86, 2000
"This review article updates current thoughts on physiological background, methodology and clinical usefulness of tonometry. The article concludes that the semi-continuous automated air tonometry may broaden the clinical applicability of gastrointestinal luminal tonometry as a monitoring tool in variety of conditions."

Jacob SM, Takala J
Importance of the splanchnic circulation
International Journal of Intensive Care for a Global Perspective on Critical Care, Vol. 6, No. 2:42 -46, 1999
"This article reviews the physiology and pathophysiology of the splanchnic circulation as well as consequences of impared splanchnic perfusion assessed by gastric tonometry."

Jakob SM, Takala J
Gut perfusion in the critically ill
Intensive Care Medicine, Vol. 26, No. 26:813-815, 2000
"This article is a review of four articles describing recent studies that address the issue of splanchnic hemodynamics and regulatory mechanisms under various conditions that are frequently present in critically ill patients."

Last updated: 1 September 2000
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