Yu-Jen Cheng1, Eing-Long Kao. 1. Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.
Abstract
PURPOSE: Quickly differentiating patients who need emergency salvage operation for caustic ingestion injury from those who do not remains difficult. We thus conducted a retrospective study to assess whether arterial blood gas (ABG) analysis is helpful for deciding on the best management plan. METHODS: We divided 129 patients with caustic ingestion injuries into two groups according to treatment. Group 1 consisted of 30 patients who underwent surgery and two who should have. Group 2 consisted of 97 patients treated conservatively. The 30 operated patients in group 1 were further divided into two groups according to whether they survived (group 3) or died (group 4). We analyzed and compared ABG data between groups 1 and 2, and between groups 3 and 4. RESULTS: In groups 1 and 2, the mean pH was 7.22 +/- 0.12 and 7.38 +/- 0.06, respectively, and the mean base excess (BE) was -12.0 +/- 5.2 and -1.8 +/- 3.7, respectively. Both these values were significantly different between groups 1 and 2 (P < 0.001). In groups 3 and 4, the mean pH was 7.27 +/- 0.09 and 7.11 +/- 0.11, respectively, and the mean BE was -10.3 +/- 4.7 and -16.1 +/- 4.6, respectively. Both these values were significantly different between groups 3 and 4 (P < 0.001 and P < 0.005, respectively). CONCLUSIONS. ABG data can help make the right decision about treatment. An arterial pH lower than 7.22 or a BE lower than -12.0 indicates severe injury, and an emergency salvage operation should be seriously considered.
PURPOSE: Quickly differentiating patients who need emergency salvage operation for caustic ingestion injury from those who do not remains difficult. We thus conducted a retrospective study to assess whether arterial blood gas (ABG) analysis is helpful for deciding on the best management plan. METHODS: We divided 129 patients with caustic ingestion injuries into two groups according to treatment. Group 1 consisted of 30 patients who underwent surgery and two who should have. Group 2 consisted of 97 patients treated conservatively. The 30 operated patients in group 1 were further divided into two groups according to whether they survived (group 3) or died (group 4). We analyzed and compared ABG data between groups 1 and 2, and between groups 3 and 4. RESULTS: In groups 1 and 2, the mean pH was 7.22 +/- 0.12 and 7.38 +/- 0.06, respectively, and the mean base excess (BE) was -12.0 +/- 5.2 and -1.8 +/- 3.7, respectively. Both these values were significantly different between groups 1 and 2 (P < 0.001). In groups 3 and 4, the mean pH was 7.27 +/- 0.09 and 7.11 +/- 0.11, respectively, and the mean BE was -10.3 +/- 4.7 and -16.1 +/- 4.6, respectively. Both these values were significantly different between groups 3 and 4 (P < 0.001 and P < 0.005, respectively). CONCLUSIONS. ABG data can help make the right decision about treatment. An arterial pH lower than 7.22 or a BE lower than -12.0 indicates severe injury, and an emergency salvage operation should be seriously considered.
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