Gastric Tonometry Guided Therapy In Critical Care Patients: A Systematic Review And Meta-analysis

Objective: The value of gastric intramucosal p H(p Hi) can be calculated from the tonometrically measured partial pressure of carbon dioxide(2) in the stomach and the arterial bicarbonate content. Low p Hi and increase of the difference between gastric mucosa and arterial 2(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 p Hi or 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 Pub Med, EMBASE, the Cochrane Library and Clinical Trials.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 p Hi 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 p Hi on admission partially drive the ultimate result of this outcome; it may indicate that these patients may be more sensitive to this therapy.