Gastric tonometry guided therapy in critical care patients: a systematic review and meta-analysis

Abstract

Abstract Introduction The value of gastric intramucosal pH (pHi) can be calculated from the tonometrically measured partial pressure of carbon dioxide ($$ {P}_{C{O}_2} $$ P C O 2 ) in the stomach and the arterial bicarbonate content. Low pHi and increase of the difference between gastric mucosal and arterial $$ {P}_{C{O}_2} $$ P C O 2 ($$ {P}_{C{O}_2} $$ P C O 2 gap) reflect splanchnic hypoperfusion and are good indicators of poor prognosis. Some randomized controlled trials (RCTs) were performed based on the theory that normalizing the low pHi or $$ {P}_{C{O}_2} $$ P C O 2 gap could improve the outcomes of critical care patients. However, the conclusions of these RCTs were divergent. Therefore, we performed a systematic review and meta-analysis to assess the effects of this goal directed therapy on patient outcome in Intensive Care Units (ICUs). Methods We searched PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials comparing gastric tonometry guided therapy with control groups. Baseline characteristics of each included RCT were extracted and displayed in a table. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. Another measure of effect (risk difference, RD) was used to reassess the effects of gastric tonometry on total mortality. We performed sensitivity analysis for total mortality. Continuous outcomes were presented as standardised mean differences (SMDs) together with 95% CIs. Results The gastric tonometry guided therapy significantly reduced total mortality (OR, 0.732; 95% CI, 0.536 to 0.999, P = 0.049; I2 = 0%; RD, −0.056; 95% CI, −0.109 to −0.003, P = 0.038; I2 = 0%) when compared with control groups. However, after excluding the patients with normal pHi on admission, the beneficial effects of this therapy did not exist (OR, 0.736; 95% CI 0.506 to 1.071, P = 0.109; I2 = 0%). ICU length of stay, hospital length of stay and days intubated were not significantly improved by this therapy. Conclusions In critical care patients, gastric tonometry guided therapy can reduce total mortality. Patients with normal pHi on admission contributed to the ultimate result of this outcome; it may indicate that these patients may be more sensitive to this therapy.