Skip to main content
SpringerLink
Log in

New Objectives in the Resuscitation of the Critically Ill

  • Conference paper
Computing and Monitoring in Anesthesia and Intensive Care

  • 86 Accesses

Abstract

The recent development of a noninvasive and indirect method. for measuring the intramucosal pH in the gut of patients has allowed clinicians to detect the presence of defective tissue oxygenation hours to days in advance of the development of overt or uncompensated shock, and to anticipate the development of a “leaky” gut before the development of its putative consequence, multiple systems organ failure. The measurements have the potential to improve outcome by enabling clinicians to achieve complete resuscitation from uncompensated shock, and its associated development of a leaky gut, in addition to resuscitation from uncompensated shock. The measurements have also enabled an accurate diagnosis of intestinal ischemia to ne made hours to days before transmural infarction develops allowing clinicians to intervene in time to prevent the catastrophic consequences of this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Andersen LW, Baek L, Degn H, Lehd J, et al (1987) Presence of circulating endotoxins during cardiac operations. Journal of Thoracic and Cardiovascular Surgery 93:115–119.

    PubMed  CAS  Google Scholar 

  • Antonsson JB, Boyle CC, Kruithoff KL, Wang H et al. (1990) Validation of tonometric measurement of gut intramural pH during endotoxemia and mesenteric occlusion in pigs. American Journal of Physiology. (259) Gastrointest. Liver Physiol. 22: G519–523.

    Google Scholar 

  • Bennion RS, Wilson SE & Williams RA (1984) Early portal anaerobic bacteremia in mesenteric ischemia. Archives of Surgery 119: 151–155.

    Article  PubMed  CAS  Google Scholar 

  • Berg RD (1985) Bacterial translocation from the intestines. Experimental Animals 34: 1–16.

    PubMed  CAS  Google Scholar 

  • Bolen HG (1984) Tissue oxygenation and splanchnic blood flow. In Sheperd AP & Granger DN (eds) Physiology of the Intestinal Circulation pp 143–151. New York: Raven Press.

    Google Scholar 

  • Brigham KL & Meyrick B (1986) Endotoxin and lung injury. American Review of Respiratory Disease 133: 913–927.

    PubMed  CAS  Google Scholar 

  • Buchman TG, Haglund EH, Hamilton SR et al (1989) The development of multiple organ failure in swine following splanchnic ischemia in response to cardiogenic shock. Gastroenterology 96: A23.

    Google Scholar 

  • Bulkley GB & Melihan JE (1988) Vasoactive humoral mediators and the splanchnic circulation in shock. Progress in Clinical and Biological Research 264: 91–100.

    PubMed  CAS  Google Scholar 

  • Bulkley GB, Womack WA, Downey JM, Kvietys PR, & Granger DN (1986) Collateral blood flow in segmental intestinal ischemia: effects of vasoactive agents. Surgery 100: 157–166, 1986.

    PubMed  CAS  Google Scholar 

  • Cahill CJ (1983) Prevention of postoperative renal failure in patients with objective jaundice - the role of bile salts. British Journal of Surgery 70: 590–595.

    Article  PubMed  CAS  Google Scholar 

  • Carrico CJ, Meakins JL, Marshall JC, Fry D, Maier RV: (1986) Multiple-organ-failure syndrome. Archives of Surgery 121: 196 – 208.

    Article  PubMed  CAS  Google Scholar 

  • Coraim F, Pauser G, Stellwag F, Werner T, & Zeigler W: (1985) Positive hemodynamics in post-cardiac modification surgery by hemofiltration surgical patients. An improved method for representation of myocardial depressant factor in haemofiltrate. Anaesthetist 34: 236–240.

    CAS  Google Scholar 

  • Cuevas P & Fine J: (1973) Production of fatal endotoxic shock by vasoactive substances. Gastroenterology 64: 285–291.

    PubMed  CAS  Google Scholar 

  • Deitch EA, (1990) Selective decontamination of the gut-Is it enough? Critical Care Medicine 18: 1043–1044.

    Article  PubMed  CAS  Google Scholar 

  • Deitch EA Berg R, & Specian R (1987) Endotoxin promotes the translocation of bacteria from the gut. Archives of Surgery 122: 185–190.

    Article  PubMed  CAS  Google Scholar 

  • Deitch EA, & Bridges RM (1987) Effect of stress and trauma on bacterial translocation from the gut. Journal of Surgical Research 42: 536–542.

    Article  PubMed  CAS  Google Scholar 

  • Deitch EA & Mclntyre RB (1987) Effect of stress and trauma on bacterial translocation from the gut. Journal of Surgical Research 42: 536–542.

    Article  PubMed  CAS  Google Scholar 

  • Driks MR, Craven DE, Celli BR et al (1987) Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. New Enqland Journal of Medicine 317: 1376–1382.

    Article  CAS  Google Scholar 

  • Doglio GR, Pusajo JF, Bonfigli GC et al. (1990) Predictive value of stomach mucosal pH in ICU patients. Chest 98: 2 54S.

    Google Scholar 

  • Fabian TC, Croce MA, Voeller GR (1988) Bacteremia following traumatic shock. Circulatory Shock 24: 278.

    Google Scholar 

  • Fink MP, Antonsson JB, Wang H, Rothschild HR.(1991) Etiology of increased intestinal permeability in endotoxin pigs: limited role for mesenteric hypoperfusion. Archives of Surgery 126(2):211–218.

    Article  PubMed  CAS  Google Scholar 

  • Fiddian-Green RG (1990) Gut mucosal ischemia during cardiac surgery. Seminars in Cardiovascular Surgery. 2: 1–11.

    Google Scholar 

  • Fiddian-Green RG. Should measurements of tissue pH and PO2 be included in the routine monitoring of ICU patients? Critical Care Medicine 19(2): 141–143.

    Google Scholar 

  • Fiddian-Green RG (1989) Studies in splanchnic ischemia and multiple organ failure. In Marston A, Bulkley GB, Fiddian- Green RG & Haglund UH (eds) Splanchnic Ischemia and Multiple Organ Failure pp 349 – 363. London: Edward Arnold

    Google Scholar 

  • Fiddian-Green RG (1988) Splanchnic ischemia and multiple organ failure in the critically ill. Annals of the Royal College of Surgeons of England 70: 128–134.

    PubMed  CAS  Google Scholar 

  • Fiddian-Green RG (1989) Stress ulceration: A focal manifestation of non-occlusive ischemia. In Marston A, Bulkley G, Fiddian-Green RG & Haglund UH (eds) Splanchnic Perfusion and Multiple Organ Failure, pp 55–259.

    Google Scholar 

  • Fiddian-Green RG: Vascular Disease of the Gut. In: Textbook of Internal Medicine. Kelly W (ed) Lippincott.

    Google Scholar 

  • Fiddian-Green RG, Amelin PM, Cutler BS, et al (1986)

    Google Scholar 

  • The prediction of the development of sigmoid ischemia on the day of aortic surgery from indirect measurements of intramural pH on the colon. Archives of Surgery 121: 654–660.

    Google Scholar 

  • Fiddian-Green RG, Amelin P, Baker S (1987) Predictive value of transient episodes of gut ischemia for death after cardiac and aortic operations. In: Tsuchiya M, Asano M, Mishima Y, & Oda M.(eds) Microcirculation: An Update. 2: 447–448. New York: Elsevier Science Publishers.

    Google Scholar 

  • Fiddian-Green RG, Baker S (1987): Predictive value of stomach wall pH for complications after cardiac operations; a comparison with other monitoring. Critical Care Med 15: 153–156.

    Article  CAS  Google Scholar 

  • Fiddian-Green RG, Baker S (1988) Hospital acquired pneumonia in ICU patients: product of aspiration or gastrointestinal translocation. Circulatory Shock 24: 279.

    Google Scholar 

  • Fiddian-Green RG, Gantz NM (1987) Transient episodes of sigmoid ischemia and their relation to infection from intestinal organisms after abdominal aortic operations. Critical Care Medicine 15: 835–839.

    Article  PubMed  CAS  Google Scholar 

  • Fiddian-Green RG, McGough GE, Pittenger G, & Rothman E (1983) Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology 85: 613–620.

    PubMed  CAS  Google Scholar 

  • Fiddian-Green RG, Pittenger G, & Whitehouse WM (1982) Back diffusion of CO2 and its influence on the intramural pH in gastric mucosa. Journal of Surgical Research 33: 39–48.

    Article  PubMed  CAS  Google Scholar 

  • Fiddian-Green RG, Stanley JC, Nostrant T, & Phillips D (1989) Chronic gastric ischemia: a cause of chronic abdominal pain identified from the presence of acidosis in the wall of the stomach. Journal of Cardiovascular Surgery 30: 852–859.

    PubMed  CAS  Google Scholar 

  • Fink MP, Cohn SP, Lee PC, et al (1989) Effect of lipopolysaccharide on intestinal intramucosal hydrogen ion concentration in pigs: Evidence of gut ischemia in normodynamic model of septic shock. Critical Care Medicine 17: 641–646.

    Article  PubMed  CAS  Google Scholar 

  • Fink MP & Fiddian-Green RG (1989) Care of the gut in the critically ill. In Marston A, Bulkley GB, Fiddian-Green RG, & Haglund UH (eds). Splanchnic Perfusion and Multiple Organ Failure, pp. 377–386. London: Edward Arnold.

    Google Scholar 

  • Fink MP, Rothschild HR, Deniz YF et al (1989): Systemic and mesenteric O2 metabolism in endotoxin pigs: effect of ibuprofen and meclofenamate. Journal of Applied Physiology 67: 1950–1957.

    PubMed  CAS  Google Scholar 

  • Granger HJ, Meininger GA, Barnes GE & Goodman AH (1984) Microvascular control of intestinal oxygenation. In Shepherd AP,& Granger DN (eds): In Physiology of Intestinal Circulation, pp. 261–273 Raven Press.

    Google Scholar 

  • Grum CM, Fiddian-Green RG, Pittenger GL. et al (1984) Adequacy of tissue oxygenation in intact dog intestine. Journal of Applied Physiology 56: 1065–1069.

    PubMed  CAS  Google Scholar 

  • Gutierrez G, & Bismar H (1990) Distribution of blood flow in the critically ill patient. In Wendt M & Lawin P (eds) Oxygen Transport in the Critically 111 Patient. Anaesthesiology and Intensive Care Medicine. Berlin, Springer-Verlag, 1990; 215: 127–135.

    Google Scholar 

  • Gys T, Hubens A, Neels H, Lauwers LF, & Peeter R (1988) The prognostic value of gastric intramural pH in surgical intensive care patients. Critical Care Medicine 16: 1222 – 1224.

    Article  PubMed  CAS  Google Scholar 

  • Haglund U (1988) The splanchnic organs as the source of toxic mediators in shock. Progress in Clinical and Biological Research 264: 135–145.

    PubMed  CAS  Google Scholar 

  • Haglund U, Bulkley GB, & Granger DN (1987) On the pathophysiology of intestinal injury. Acta Chirurgica Scandinavica 153: 321–324.

    PubMed  CAS  Google Scholar 

  • Haglund U & Fiddian-Green RG (1989) Assessment of adequate tissue oxygenation in shock and critical illness: oxygen transport in sepsis: Intensive Care Medicine 15: 475–477.

    PubMed  CAS  Google Scholar 

  • Haglund U (1988) The splanchnic organs as the source of toxic mediators in shock. In Progress in Clinical and Biological Research. 264: 135–145.

    PubMed  CAS  Google Scholar 

  • Haglund U, Jodal M, & Lundgren O (1984) The small bowel in arterial hypotension and shock. In Shepherd AP & Granger DN (eds) Physiology of the Intestinal Circulation, pp 305–320. New York: Raven Press.

    Google Scholar 

  • Haglund U, Montgomery A, & Borgstrom A (1990) Intraluminal pancreatic proteases and intestinal mucosal injury during ischemia and reperfusion. Circulatory Shock 31: 36.

    Google Scholar 

  • Hartmann M, Montgomery A, Jonsson K, & Haglund U. Tissue oxygenation in hemorrhagic shock measured as transcutaneous oxygen tension, subcutaneous oxygen tensions and gastrointestinal pHi. An experimental study in pigs. Critical Care Medicine (in press)

    Google Scholar 

  • Heard SO, Helmsmoortel CM, Kent JC, Shahnariaa A, & Fink MP (1990) Gastric tonometry in healthy volunteers: effect of ranitidine on calculated intramural pH. Critical Care Medicine 19(2) 271 -274.

    Article  Google Scholar 

  • Hunt TK, Rabkin J, Jensen JA. et al (1987) Tissue oximetry: An interim report. World Journal of Surgery 11: 126–132.

    Article  PubMed  CAS  Google Scholar 

  • Kittila K, Niinikoski J, Haglund U. Visceral and peripheral tissue perfusion after cardiac surgery. Scandinavian Journal of Thoracic and Cardiovascular Surgery (in press).

    Google Scholar 

  • Knight-George AB, Bihari DJ: (1991) Gastric intramural pH and stress ulcer prophylaxis in critically ill patients. Clinical Intensive Care Medicine 1(6) 249–255.

    Google Scholar 

  • Landow L, Phillips D, Prevost D. et al (1990) Correlation between gastric intramucosal pH, hepatic venous lactate and oxygen saturation. 56th Annual Scientific Assembly American College of Chest Physicians Toronto Canada, October 22–26.

    Google Scholar 

  • Levin J, Tomasulo PA & Oser RS (1970) Detection of endotoxin in human blood and demonstration of an inhibitor. Journal of Lababoratory and Clinical Medicine 75: 903 – 911.

    CAS  Google Scholar 

  • Lillehei RC (1957) The intestinal factor in irreversible hemorrhagic shock. Surgery 42: 1043–1053.

    PubMed  CAS  Google Scholar 

  • McClelland P, Murray AE, Williams PS et al (1990) Reducing sepsis in severe combined acute renal and respiratory failure by selective decontamination of the digestive tract. Critical Care Medicine 18: 935–939.

    Article  PubMed  CAS  Google Scholar 

  • Miller CL, Szabo G & Wu JY (1989) Splanchnic Ischemia as a cause of immunological disturbances. In Marston A, Bulkley GB, Fiddian-Green RG, Haglund UH (eds) Splanchnic Ischemia and Multiple Organ Failure, pp 237–247. London: Edward Arnold.

    Google Scholar 

  • Montgomery A, Hartmann M, Jonsson K & Haglund U (1989) Intramucosal pH measurement with tonometers for detecting gastrointestinal ischemia in porcine hemorrhagic shock. Circulatory Shock 29: 319–327.

    PubMed  CAS  Google Scholar 

  • Morris DD, Moore JN, Fischer K, Tarleton RL (1990) Endotoxin-induced tumor necrosis factor activity production by equine peritoneal macrophages. Circulatory Shock 30:229 – 236.

    PubMed  CAS  Google Scholar 

  • Nelson DP, King CE, Dodd SL, Schumacker PT & Cain SM (1987) Systemic and intestinal limits of O2 extraction in the dog. Journal of Applied Physiology 63: 387–394.

    PubMed  CAS  Google Scholar 

  • Ohman, U (1984) The effects of luminal distension and obstruction of the intestinal circulation. In Shepherd AP, Granger DN (eds): Physiology of the Intestinal Circulation, pp. 321–334.

    Google Scholar 

  • Palizas F (1990) Transcript of workshop on “Tonometrically measured gut pH as an index of tissue oxygenation”. 5th European Congress on Intensive Care Medicine, Amsterdam.

    Google Scholar 

  • Papa M, Halperin Z, Rubinstein E et al (1983) The effect of ischemia of the dog’s colon on transmural migration of bacterial and endotoxin. Journal of Surgical Research 35: 264–269.

    Article  PubMed  CAS  Google Scholar 

  • Parks DA, Bulkley GB, Granger DN, Hamilton SR & McCord JM (1982) Ischemic injury in the cat small intestine: role of superoxide radicals. Gastroenterology 82: 9–15.

    PubMed  CAS  Google Scholar 

  • Poole JW, Sammartano RJ, Boley SJ (1987) Hemodynamic basis of the pain of chronic mesenteric ischemia. American Journal of Surgery 153: 171–176.

    Article  PubMed  CAS  Google Scholar 

  • Porter JM, Sussman MC & Bulkley GB (1989) Splanchnic vasospasm in circulatory shock. In Marston A, Bulkley GB, Fiddian- Green RG, & Haglund UH (eds) Splanchnic Ischemia and Multiple Organ Failure. London: Edward Arnold pp 73–88.

    Google Scholar 

  • Richardson PDI (1984) Pharmacology of intestinal blood flow and oxygen uptake. In Shepherd AP & Granger DN (eds): Physiology of the Intestinal Circulation, pp 393–402 New York:Raven Press.

    Google Scholar 

  • Schiedler MG, Cutler BS & Fiddian-Green RG (1987) Sigmoid intramural pH for prediction of ischemic colitis during aortic surgery. Archives of Surgery 122: 881–886.

    Article  PubMed  CAS  Google Scholar 

  • Shoemaker WC, Appel PL, Kram HB, Waxman K, & Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186.

    Article  PubMed  CAS  Google Scholar 

  • Shoemaker WC, Appel PL & Kram HB (1988) Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Critical Care Medicine 16: 117–120.

    Article  Google Scholar 

  • Shute K (1977) Effect of intraluminal oxygen on endotoxin absorption in experimental occlusion of the superior mesenteric artery. Gut 18: 567–570,1977.

    Article  PubMed  CAS  Google Scholar 

  • Sori AJ, Rush BF, Lysz TW, Smith S & Machiedo GW (1988) The gut as source of sepsis after haemorrhagic shock. American Journal of Surgery 155: 185–192.

    Article  Google Scholar 

  • Stoutenbeek CP, van Saene HK, Miranda DR & Zandra DF (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Medicine 10: 185–192.

    Article  PubMed  CAS  Google Scholar 

  • Taylor KM (1986) Pulsatile perfusion. In Taylor KM (ed) Cardiopulmonary Bypass: Principles and Management, pp 85–114. Baltimore: Williams and Wilkins.

    Google Scholar 

  • Taylor KM, Brannan JJ, Bain WH, Caves PK & Morton I J. (1979) Role of angiotensin II in the development of peripheral vasoconstriction during cardiopulmonary bypass. Cardiovascular Research 13: 269 – 273.

    Article  PubMed  CAS  Google Scholar 

  • Zeigler E, Fisher C, Sprung C, et al (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human antibody against endotoxin. New Eng J Med 324: 429 – 436.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Massachusetts Medical Center, Worcester, MA, USA

    Richard G. Fiddian-Green M.D.

Authors
  1. Richard G. Fiddian-Green M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Hamamatsu University School of Medicine, Japan

    Kazuyuki Ikeda M.D. (Professor and Chairman), Matsuyuki Doi M.D. (Assistant Professor), Tomiei Kazama M.D. (Associate Professor) & Kazuo Sato M.D. (Associate Professor) (Professor and Chairman),  (Assistant Professor),  (Associate Professor) &  (Associate Professor)

  2. Department of Anesthesiology, Hirosaki University, Japan

    Tsutomu Oyama M.D. (Emeritus Professor) (Emeritus Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 1992 Springer-Verlag Tokyo

About this paper

Cite this paper

Fiddian-Green, R.G. (1992). New Objectives in the Resuscitation of the Critically Ill. In: Ikeda, K., Doi, M., Kazama, T., Sato, K., Oyama, T. (eds) Computing and Monitoring in Anesthesia and Intensive Care. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68201-1_135

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-68201-1_135

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-68203-5

  • Online ISBN: 978-4-431-68201-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation