Gastric-arterial PCO2 gradient does not reflect systemic and splanchnic hemodynamics or oxygen transport after cardiac surgery.
Gastric mucosal-arterial PCO2 gradient (P(g-a)CO2) is used to assess splanchnic perfusion and oxygenation. We evaluated whether P(g-a)CO2 reflects whole body (Q) and splanchnic (Qsp) blood flow, oxygen delivery (DO2) and consumption (VO2) after coronary artery by pass graft (CABG) operation. Thirty patients received dobutamine or dopexamine to increase cardiac index, 15 patients enalapril or sodium nitroprusside to lower blood pressure, and 30 patients were controls. We measured Q, Qsp (hepatic vein catheter and indocyanine green), and gastric mucosal PCO2 (nasogastric tonometer) before and after interventions. Multiple linear regression model showed that none of the changes in Q, Qsp, and splanchnic or systemic DO2 and VO2 significantly explained changes in P(g-a)CO2 (deltaP(g-a)CO2). All independent variables together explained only 7% of deltaP(g-a)CO2. Increased splanchnic blood flow (0.65 +/- .19 vs. 0.94 +/- .31 L/min/m2, P < 0.001) and increased splanchnic DO2 (101 +/- 28 vs. 143 +/- 42 mL/min/m2, P < 0.001) during catecholamine infusions were associated with increased P(g-a)CO2 (8 +/- 8 vs. 11 +/- 7 mmHg, P = 0.003). P(g-a)CO2 does not reflect whole body or splanchnic blood flow, DO2 or VO2 after CABG operations. The physiology of P(g-a)CO2 is complex and therefore it is difficult for clinicians to interpret changes in gastric mucosal-arterial PCO2 gradient in individual patients after cardiac surgery.
Department of Anesthesiology and Critical Care, Kuopio University Hospital, Finland.
A
A
Uusaro
J A
JA
Russell
K R
KR
Walley
J
J
Takala
D000959:Antihypertensive Agents / Q000494:pharmacology; D001158:Arteries; D002245:Carbon Dioxide / Q000097:blood*; D002317:Cardiovascular Agents / Q000494:pharmacology*; D002395:Catecholamines / Q000494:pharmacology; D001026:Coronary Artery Bypass; D004280:Dobutamine / Q000494:pharmacology; D004298:Dopamine / Q000031:analogs & derivatives / Q000494:pharmacology; D004656:Enalapril / Q000494:pharmacology; D005753:Gastric Mucosa / Q000098:blood supply / Q000378:metabolism*; D006439:Hemodynamics / Q000187:drug effects; D006635:Histamine H2 Antagonists / Q000494:pharmacology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D009599:Nitroprusside / Q000494:pharmacology; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000187:drug effects; D010313:Partial Pressure; D011184:Postoperative Period; D013152:Splanchnic Circulation / Q000187:drug effects; D014665:Vasodilator Agents / Q000494:pharmacology
D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D002395:Catecholamines; D006635:Histamine H2 Antagonists; D014665:Vasodilator Agents; D002245:Carbon Dioxide; D009599:Nitroprusside; C046318:dopexamine; D004280:Dobutamine; D004656:Enalapril; D010100:Oxygen; D004298:Dopamine