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It was with great anticipation that we began to read the article by Barie1 on advances in critical care monitoring. Dr Barie makes some excellent points; however, the article should have been labeled as representing the opinions of him only.
In particular, his comments on gastric tonometry showed either severe bias or lack of information. Dr Barie may or may not be aware that air is now used instead of saline solution for insufflation of the balloon. The equilibration time used routinely now is 15 to 30 minutes, not 2 to 4 hours. In addition, the analysis is performed by an infrared sensor and not by a conventional blood gas analyzer. The technique, therefore, is no longer "cumbersome" but is now a matter of connecting the catheter to the machine and turning on the switch. Re-equilibration of the machine needs to be performed every 2 months.
Considering that there are more than 700 articles in the literature at present, it seems that tonometry has some merit. As numerous articles in recent literature have shown, gastric tonometry is providing "tissue-specific" information that cannot be provided by any other source that analyzes "global" measurements. The exciting challenge facing critical care physicians is whether guiding resuscitation measures to these tissue-specific end points can prevent the so-called ischemia-reperfusion injury that leads to multiple organ dysfunction syndrome and eventual death. We are uncertain why the potential of gastric tonometry was not recognized in this article.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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