TITLE

Gastric hypercarbia and adverse outcome after cardiac surgery

AUTHOR(S)
Kavarana, Minoo N.; Frumento, Robert J.; Hirsch, Andrew L.; Oz, Mehmet C.; Lee, Daniel C.; Bennett-Guerrero, Elliott
PUB. DATE
May 2003
SOURCE
Intensive Care Medicine;May2003, Vol. 29 Issue 5, p742
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective. : It has been postulated that splanchnic ischemia, as manifested by gastric hypercarbia, helps to trigger excessive systemic inflammation, which has been linked to the development of adverse postoperative outcome. This study examined whether gastric PCO2 values are associated with adverse outcome in cardiac surgical patients. Design and setting. Prospective cohort study in a tertiary-care hospital. Patients. 43 patients undergoing elective cardiac surgery. Interventions. Simultaneous measurements of gastric PCO2 (using automated air tonometry) and arterial PCO2 were obtained at the beginning and end of surgery. The difference (gap) between regional PCO2 and arterial PCO2 (corrected for temperature) was calculated. Adverse outcome was defined as in-hospital death or prolonged (>10 days) postoperative hospitalization. Measurements and results. Fourteen patients fulfilled the predefined definition for adverse outcome. Postoperative ICU stay and postoperative hospital length of stay were significantly longer in these patients. At the end of surgery gastric minus arterial PCO2 gap was significantly larger in patients with adverse outcome. Global hemodynamic and perfusion related variables were not associated with adverse outcome (cardiac index, mean arterial pressure, mixed venous oxygen saturation, arterial lactate, arterial base excess). Conclusions. Gastric minus arterial PCO2 gap after surgery is larger in patients with adverse postoperative outcome, which supports the theory that gastrointestinal reduced perfusion is relevant to the pathogenesis of postoperative morbidity
ACCESSION #
16629415

 

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