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(Chest. 2003;123:475S-481S.)
© 2003 American College of Chest Physicians

Gastric Tonometry*

The Role of Mucosal pH Measurement in the Management of Trauma

S. Morad Hameed, MD, MPH and Stephen M. Cohn, MD, FCCP

* From the Departments of Surgery and Critical Care Medicine (Dr. Hameed), University of Calgary, Calgary, Alberta, Canada; and Divisions of Trauma/Surgical Critical Care (Dr. Cohn), Ryder Trauma Center, University of Miami, Miami, FL.

Correspondence to: Stephen M. Cohn, MD, FCCP, Daughtry Family Department of Surgery, Divisions of Trauma and Surgical Critical Care, PO Box 016960 (D-40), Miami, FL 33131; e-mail: stephen.cohn{at}miami.edu

Effective management of hemorrhagic shock depends on titration of therapies against reliable resuscitation end points. Conventional clinical and laboratory indexes of shock are often slow to respond to progressive circulatory compromise. GI mucosal ischemia resulting from redistribution of blood flow may, however, precede uncompensated shock and may compound the initial hemorrhagic insult by touching off cascades of inflammatory responses. Trauma patients with evidence of subclinical GI ischemia have been shown to have poor outcomes. Gastric tonometry, by detecting the presence of gastric intramucosal acidosis as a proxy of splanchnic hypoperfusion, may facilitate more timely and rational shock resuscitation. This article reviews the development and validation of gastric tonometry and summarizes the clinical studies that have used this modality to guide the management of shock in trauma patients.

Key Words: gastric tonometry • mucosal acidosis • shock




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Chest, November 1, 2005; 128(5_suppl_2): 554S - 560S.
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