Continuous monitoring of gastric intraluminal carbon dioxide pressure, cardiac output, and end-tidal carbon dioxide pressure in the perioperative period in patients receiving cardiovascular surgery using cardiopulmonary bypass.
OBJECTIVE
To verify the hypothesis that the gastric intraluminal PCO2 (PgCO2) changes independently of the change in cardiac output (CO) during and after cardiovascular surgery using cardiopulmonary bypass (CPB), and that the elevation of PgCO2 affects the patients' morbidity.


METHODS
Prospective, noninterventional study.


METHODS
Medical/surgical intensive care unit and operating theater of a university hospital.


METHODS
Sixteen adults patients receiving elective cardiovascular surgery using CPB.


METHODS
None.


RESULTS
After induction of anesthesia, the patients were fitted with a gastric tube equipped at the tip with a CO2 sensor (ion-selective field effect transistor) that can continuously measure real-time PgCO2, and a pulmonary artery catheter capable of monitoring continuous CO (CCO) and end-tidal CO2. Data from the devices was uploaded to a personal computer every 2 mins until the catheter was pulled off based on clinical judgment (PgCO2 values were blinded to everyone except the investigator). One patient expired as a result of multiple organ failure subsequent to sepsis, and postoperative morbidity assessed by the peak SOFA (sequential organ failure assessment) score (mean +/- SD 6.9 +/- 3.5; range, 2-13) was correlated with the peak PgCO2 during intensive care unit stay (mean +/- SD 74.1 +/- 30.7 mm Hg; range, 45-169 mm Hg) (p < .01, by regression analysis). The peak PgCO2 during surgery (mean +/- SD 71.1 +/- 18.1 mm Hg; range, 44-115 mm Hg) had no correlation with the postoperative morbidity. From analysis of CCO before, during, and after returning from the above 60 mm Hg of PgCO2, PgCO2 changed independently of CCO.


CONCLUSIONS
PgCO2 changed independently of CCO, and its postoperative elevation was related to morbidity, even in the group of patients with a good outcome. Continuous monitoring of PgCO2 is useful for the detection of morbidity and can be expected to help elucidate the pathophysiology of change of PgCO2.
Imai
Takasuke
T
Department of Critical Care Medicine, Tokyo Medical and Dental University, Japan. taka.ikasika.ccm@tmd.ac.jp
Sekiguchi
Tetsushi
T
Nagai
Yuko
Y
Morimoto
Takushi
T
Nosaka
Toshihisa
T
Mitaka
Chieko
C
Makita
Koushi
K
Sunamori
Makoto
M
D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000032:analysis*; D002302:Cardiac Output / Q000502:physiology*; D002315:Cardiopulmonary Bypass; D013504:Cardiovascular Surgical Procedures; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010313:Partial Pressure; D011446:Prospective Studies; D013270:Stomach / Q000502:physiology*
D002245:Carbon Dioxide