Intraabdominal pressure and gastric intramucosal pH: is there an association?
This study evaluated the potential association between increased intraabdominal pressure (IAP) and abnormally low gastric intramucosal pH (pHi) (</= 7.32) in postoperative patients and assessed its effect on patient outcome. Altogether 73 patients undergoing major abdominal surgery over a 9-month period were studied prospectively. All underwent gastric tonometry and intravesical IAP measurements three time daily. An IAP of >/= 20 mmHg and a pHi of </= 7.32 were considered abnormal. The development of the following complications were also documented: hypotension [mean aortic pressure (MAP) < 80 mmHg], abdominal sepsis, renal impairment, and death. The median APACHE II score was 16 (range 5-34). Twenty-two patients had upper gastrointestinal (GI) surgery, 27 lower GI surgery, and 24 aortic surgery; 44 of these patients underwent emergency surgery. Abnormal pHi (</= 7.32) occurred in 36 patients while on the intensive care unit. Compared to patients with normal pHi, abnormal pHi patients were 11.3 times (3.2-43.5) [odds ratio +/- 95% CI] more likely to have an increased IAP. Abnormal pHi was significantly associated with hypotension (chi2 = 6.8;p = 0.009), sepsis (chi2 = 3.7;p = 0.06), renal impairment (chi2 = 28.3;p = 0. 0000001), relaparotomy (chi2 = 4.1;p = 0.04), and death (chi2 = 9. 7;p = 0.002). This study demonstrated a significant clinical association between increased IAP and abnormal pHi. An abnormally low pHi was associated with poor outcome.
Sugrue
M
M
Department of Surgery, Liverpool Hospital, Elizabeth Street, Liverpool, Sydney 2170, Australia.
Jones
F
F
Lee
A
A
Buist
M D
MD
Deane
S
S
Bauman
A
A
Hillman
K
K
D000005:Abdomen / Q000503:physiopathology*; D000006:Abdomen, Acute / Q000378:metabolism / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005753:Gastric Mucosa / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007362:Intensive Care Units; D007813:Laparotomy; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011312:Pressure; D011446:Prospective Studies