title: 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.
abstract: 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.
authors.affiliation: Department of Critical Care Medicine, Tokyo Medical and Dental University, Japan. taka.ikasika.ccm@tmd.ac.jp
authors.forename: Takasuke
authors.initials: T
authors.lastname: Imai
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Sekiguchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nagai
authors.forename: Takushi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Nosaka
authors.forename: Chieko
authors.initials: C
authors.lastname: Mitaka
authors.forename: Koushi
authors.initials: K
authors.lastname: Makita
authors.forename: Makoto
authors.initials: M
authors.lastname: Sunamori
mesh_terms: 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*
chemical_list: D002245:Carbon Dioxide