Gastric hypercarbia and adverse outcome after cardiac surgery.
OBJECTIVE
It has been postulated that splanchnic ischemia, as manifested by gastric hypercarbia, helps to trigger excessive systemic inflammation, which has been linked to the development of adverse postoperative outcome. This study examined whether gastric PCO(2) values are associated with adverse outcome in cardiac surgical patients.


METHODS
Prospective cohort study in a tertiary-care hospital.


METHODS
43 patients undergoing elective cardiac surgery.


METHODS
Simultaneous measurements of gastric PCO(2) (using automated air tonometry) and arterial PCO(2) were obtained at the beginning and end of surgery. The difference (gap) between regional PCO(2) and arterial PCO(2) (corrected for temperature) was calculated. Adverse outcome was defined as in-hospital death or prolonged (>10 days) postoperative hospitalization.


RESULTS
Fourteen patients fulfilled the predefined definition for adverse outcome. Postoperative ICU stay and postoperative hospital length of stay were significantly longer in these patients. At the end of surgery gastric minus arterial PCO(2) gap was significantly larger in patients with adverse outcome. Global hemodynamic and perfusion related variables were not associated with adverse outcome (cardiac index, mean arterial pressure, mixed venous oxygen saturation, arterial lactate, arterial base excess).


CONCLUSIONS
Gastric minus arterial PCO(2) gap after surgery is larger in patients with adverse postoperative outcome, which supports the theory that gastrointestinal reduced perfusion is relevant to the pathogenesis of postoperative morbidity.
Kavarana
Minoo N
MN
Division Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, 630 West 168 Street, New York, NY 10032, USA.
Frumento
Robert J
RJ
Hirsch
Andrew L
AL
Oz
Mehmet C
MC
Lee
Daniel C
DC
Bennett-Guerrero
Elliott
E
D000368:Aged; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism*; D006331:Heart Diseases / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000503:physiopathology*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index