Gastric tonometry has proved to be a sensitive but not specific predictor of outcome in the critically ill. The data accumulated to date indicate that those patients able to achieve or maintain a normal gastric mucosal pH do better than those who do not. In addition, therapy aimed at improving an abnormal gastric mucosal pH has proved to be less successful. These findings may simply indicate that tonometry identifies those "responders" and "nonresponders," as becomes increasingly apparent in populations of critical care patients receiving interventional therapy. Gastric tonometry has undergone a number of methodologic changes over the last decade, seeing a switch from saline to automated gas tonometry. Along with this switch of methodology has come a deeper scrutiny of the indices used to assess gut perfusion. Most studies (including all the interventional ones) have used gastric mucosal pH. The newer indices of gut luminal PCO2 (PgCO2) referenced to arterial CO2 (PgCO2-PaCO2) or end tidal CO2 (PgCO2-PeCO2), although relatively well validated, remain to be proven as predictors of outcome or guides to interventional therapy. If we take a fresh look at the interventional trials in intensive care patients, there is a very definite trend toward benefit in the protocol groups, although they are generally reported as negative studies. There is much to be accomplished, however, before we accept the gastric tonometer as a routine tool with which to guide therapy based on gastrointestinal perfusion, including a greater understanding of gastrointestinal physiology and, as ever, the call for an adequately powered prospective randomized controlled trial to evaluate the clinical utility of gas tonometry.

译文

胃镜检查已被证明是危重病患者预后的敏感但不是特定的预测指标。迄今为止积累的数据表明,那些能够达到或维持正常胃粘膜ph值的患者比那些没有达到或保持正常胃粘膜ph值的患者做得更好。此外,旨在改善异常胃黏膜ph值的疗法已被证明不太成功。这些发现可能只是表明眼压计可以识别那些 “响应者” 和 “无响应者”,这在接受介入治疗的重症监护患者人群中越来越明显。在过去的十年中,胃眼压计经历了许多方法学上的变化,从盐水转向了自动气体眼压计。随着方法的转变,对用于评估肠道灌注的指标进行了更深入的审查。大多数研究 (包括所有介入性研究) 都使用了胃粘膜pH。与动脉CO2 (PgCO2-PaCO2) 或潮气末CO2 (PgCO2-PeCO2) 相关的肠腔PCO2 (PgCO2) 的较新指标,尽管得到了相对较好的验证,但仍有待证明是预后的预测指标或介入治疗的指南。如果我们重新审视重症监护患者的介入试验,尽管方案组通常被报道为阴性研究,但方案组仍有明显的获益趋势。然而,在我们接受胃眼压计作为指导基于胃肠道灌注的治疗的常规工具之前,还有很多事情要做,包括对胃肠道生理学有更深入的了解,以及一如既往地呼吁进行有足够动力的前瞻性随机对照试验以评估气体眼压计的临床实用性。

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