Preserved gastric tonometric variables in cardiac surgical patients administered intravenous perflubron emulsion.
Low gastric intramucosal pH (pHi) and an increased gastric-arterial PCO2 difference (CO2 gap) are markers of tissue hypoperfusion. Perfluorocarbons (PFCs) have a large oxygen-carrying capacity and release oxygen when encountering low tissue oxygen tension. Nine cardiac surgical patients instrumented for gastric tonometry were enrolled as part of a multicenter, randomized, single-blinded study of a PFC emulsion (perflubron emulsion [Oxygent]). Patients were randomized to receive PFC (n = 4) or placebo (n = 5) after intraoperative autologous blood harvesting by acute normovolemic hemodilution. At baseline there were no intergroup differences in tonometric-, hemodynamic-, or oxygen delivery-derived variables, e.g., Control group (pHi, 7.37 +/- 0.06; CO2 gap, 6.4 +/- 1.3 mm Hg) versus PFC group (pHi, 7.38 +/- 0.06; CO2 gap, 6.7 +/- 1.5 mm Hg). After acute normovolemic hemodilution, pHi was significantly lower (P < 0.01) in the Control group (7.22 +/- 0.25) than in the PFC group (7.44 +/- 0.25), and CO2 gap was significantly higher (P < 0.001) in the Control group (23.4 +/- 5.1 mm Hg) than in the PFC group (1.8 +/- 0.8 mm Hg). These differences in tonometric variables persisted during surgery. The PFC group showed a significantly (P < 0.007) shorter time to first bowel movement postoperatively (2.0 +/- 0.8 vs 5.4 +/- 1.6 days). Time to consumption of solid food was also shorter in the PFC group and almost achieved statistical significance (P = 0.056).


CONCLUSIONS
This study suggests that the administration of perflubron emulsion prevents gastrointestinal tract ischemia in cardiac surgical patients and may preserve postoperative gastrointestinal tract function.
Frumento
Robert J
RJ
Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, New York 10032-3784, USA. rf356@columbia.edu
Mongero
Linda
L
Naka
Yoshifumi
Y
Bennett-Guerrero
Elliott
E
D000368:Aged; D001804:Blood Transfusion, Autologous; D002245:Carbon Dioxide / Q000097:blood / Q000378:metabolism*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004655:Emulsions; D005466:Fluorocarbons / Q000008:administration & dosage*; D005753:Gastric Mucosa / Q000098:blood supply / Q000378:metabolism*; D006438:Hemodilution; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006842:Hydrocarbons, Brominated; D006863:Hydrogen-Ion Concentration; D007262:Infusions, Intravenous; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D010313:Partial Pressure; D016037:Single-Blind Method
D004655:Emulsions; D005466:Fluorocarbons; D006454:Hemoglobins; D006842:Hydrocarbons, Brominated; D002245:Carbon Dioxide; C003072:perflubron; D010100:Oxygen