iPH and Splanchnic Dysfunction Management

  • S. M. Jakob
Conference paper


There is evidence from experimental and clinical studies that the gastrointestinal tract is a key player in the development of endotoxemia, sepsis, and multiple organ failure [1, 2, 3, 4]. Therefore, the assessment of perfusion and function of the splanchnic organs have become of major interest, both for investigators and clinicians. The currently available clinical tools are, among others, the assessment of gastrointestinal permeability, liver function tests, such as monoethylglycine xylidide (MEGX) production from lidocaine, and many others, regional and local blood flow measurements, such as estimation of splanchnic blood flow by hepatic uptake of substances that are metabolized by the liver and distributed in the plasma, such as indocyanine green, Laser Doppler flow, and tonometry. The estimation of gastric and intestinal mucosal pH by tonometry was introduced in the 1980, and further developed during the last 15 years to semi- and fully automated methods. An impressive number of both clinical and experimental studies has been conducted so far with tonometry, but the method has not yet gained clinical acceptance. There are many reasons for this. Some are listed in Table 1.


Splanchnic Blood Flow Gastric Tonometry Laser Doppler Flow Hepatic Arterial Blood Flow Mucosal Perfusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kirton OC, Windsor J, Wedderburn R, et al (1998) Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU. Chest 113: 1064–1069PubMedCrossRefGoogle Scholar
  2. 2.
    Swank GM, Deitch EA (1996) Role of the gut in multiple organ failure: bacterial translocation and permeability changes. World J Surg 20: 411–417PubMedCrossRefGoogle Scholar
  3. 3.
    Doglio GR, Pusajo JF, Egurrola MA, et al (1991) Gastric mucosal pH as a prognostic index of mortality in critically ill patients. Crit Care Med 19: 1037–1040PubMedCrossRefGoogle Scholar
  4. 4.
    Baker JW, Deitch EA, Li M, et al (1988) Hemorrhagic shock induces bacterial translocation from the gut. J Trauma 28: 896–906PubMedCrossRefGoogle Scholar
  5. 5.
    Benjamin E, Oropello JM (1996) Does gastric tonometry work? No. Crit Care Clin 12: 587–601CrossRefGoogle Scholar
  6. 6.
    Jakob SM, Kosonen P, Ruokonen E, et al (1999) The Haldane effect—an alternative explanation for increasing gastric mucosal pCO2 gradients? Br J Anaesth 83: 740–746PubMedCrossRefGoogle Scholar
  7. 7.
    Jakob SM, Parviainen I, Ruokonen E, et al (2000) Variability of continually measured gastric-mucosal Pco2 in critically ill patients and effect of ranitidine. Intensive Care Med 26: S429CrossRefGoogle Scholar
  8. 8.
    Rendig SV Premjit SC Longhurst JC 1997 Cardiovascular reflex responses to ischemia during occlusion of celiac and/or superior mesenteric arteries. Am J Physiol 272 H791–H796Google Scholar
  9. 9.
    Fiddian-Green RG (1990) Gut mucosal ischemia during cardiac surgery. Semin Thorac Cardiovasc Surg 2: 389–399PubMedGoogle Scholar
  10. 10.
    Landow L, Phillips DA, Heard SO, et al (1991) Gastric tonometry and venous oximetry in cardiac surgery patients. Crit Care Med 19: 1226–1233PubMedCrossRefGoogle Scholar
  11. 11.
    Ruokonen E, Takala J, Kari A (1993) Regional blood flow and oxygen transport in patients with the low cardiac output syndrome after cardiac surgery. Crit Care Med 21: 1304–1311PubMedCrossRefGoogle Scholar
  12. 12.
    Parviainen I, Ruokonen E, Takala J (1995) Dobutamine-induced dissociation between changes in splanchnic blood flow and gastric intramucosal pH after cardiac surgery. Br J Anaesth 74: 277–282PubMedCrossRefGoogle Scholar
  13. 13.
    Temmesfeld-Wollbruck B, Szalay A, Mayer K, et al (1998) Abnormalities of gastric mucosal oxygenation in septic shock: partial responsiveness to dopexamine. Am J Respir Crit Care Med 157: 1586–1592PubMedGoogle Scholar
  14. 14.
    Uusaro A, Ruokonen E, Takala J (1995) Gastric mucosal pH does not reflect changes in splanchnic blood flow after cardiac surgery. Br J Anaesth 74: 149–154PubMedCrossRefGoogle Scholar
  15. 15.
    Vaisanen O, Ruokonen E, Parviainen I, et al (2000) Ranitidine or dobutamine alone or combined has no effect on gastric intramucosal-arterial PCO(2) difference after cardiac surgery. Intensive Care Med 26: 45–51PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenblum JD, Boyle CM, Schwartz LB (1997) The mesenteric circulation. Anatomy and physiology. Surg Clin North Am 77: 289–306PubMedCrossRefGoogle Scholar
  17. 17.
    Lautt WW 1985 Mechanism and role of intrinsic regulation of hepatic arterial blood flow the hepatic arterial buffer response. Am J Physiol 249 G549–G556Google Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • S. M. Jakob
    • 1
  1. 1.Department of Intensive Care MedicineUniversity HospitalBernSwitzerland

Personalised recommendations