OBJECTIVE: To assess if low gastric intramucosal pH (pHi), in the first 24 hours from trauma, is an early risk index for organ failure in severe trauma. DESIGN: Prospective clinical study. SETTING: General ICU in a university hospital. PATIENTS: Thirty-one consecutive trauma patients, aged 15 to 71 years (mean 34.2), 26 men and 5 women. MEASUREMENTS AND RESULTS: In all patients pHi was measured using a gastric tonometer. All patients presented systemic inflammatory response syndrome (SIRS) and 14 patients (45.2%) developed sepsis. Seven patients developed one or more organ failures (22.6%). Six patients died (19.4%), five because of organ failure and one because of primary brain injury. The worst 12-24 hour pHi, the worst 24 hours blood Base Excess, APACHE II and ISS were grouped by absence or presence of sepsis, organ failure and by outcome. Patients developing organ failure had pHi values (median = 7.06) significantly lower than patients who did not developed organ failure (median = 7.33) (chi 2 = 5.35; p = 0.02). CONCLUSIONS: Our data suggest that low pHi during the first 24 hours from trauma seems to be a good predictor for the development of organ failure.

APACHE↗

PubMedDate not supplied

[Do clinical or physiopathological parameters exist for rationalizing the demand for thoracic radiograms in patients admitted to an intensive care unit].

To rationalize the demand of chest radiography in Intensive Care Unit patients, 423 radiographs of 35 patients were studied prospectively. The radiologic findings were compared with clinical data, blood gas analysis and laboratory data. No significant correlation was demonstrated between pulmonary radiographic changes and patient clinical conditions classified as unchanged, improving and worsening. In contrast, a good correlation (R = 0.65; p < 0.001) was observed between the chest radiographic score of pulmonary changes and the PaO2/FiO2 ratio. Changes in this parameter may be a good reason to perform bedside chest radiographs, whereas this exam appears rather useless when PaO2/FiO2 ratio is unchanged.

Adolescent↗