A european, multicenter, observational study to assess the value of gastric-to-end tidal PCO2 difference in predicting postoperative complications.
Automated online tonometry displays a rapid, semicontinuous measurement of gastric-to-endtidal carbon dioxide (Pr-etCO2) as an index of gastrointestinal perfusion during surgery. Its use to predict postoperative outcome has not been studied in general surgery patients. We, therefore, studied ASA physical status III-IV patients operated on for elective surgery under general anesthesia and a planned duration of >2 h in a European, multicenter study. As each center was equipped with only 1 tonometric monitor, a randomization was performed if more than one patient was eligible the same day. Patients not monitored with tonometry were assessed only for follow-up. The main outcome measure was the assessment of postoperative functional recovery delay (FRD) on day 8. Among the 290 patients studied, 34% had FRD associated with a longer hospital stay. The most common FRDs were gastrointestinal (45%), infection (39%), and respiratory (35%). In those monitored with tonometry (n = 179), maximum Pr-etCO2 proved to be the best predictor increasing the probability of FRD from 34% for all patients to 65% at a cut-off of 21 mm Hg (2.8kPa) (sensitivity 0.27, specificity 0.92, positive predictive value 64%, negative predictive value 70%). We conclude that intraoperative Pr-etCO2 measurement may be a useful prognostic index of postoperative morbidity.
Department of Anesthesiology 2, CHU de Lille, Lille, France.
Gilles
G
Lebuffe
Benoît
B
Vallet
Jukka
J
Takala
Gary
G
Hartstein
Maurice
M
Lamy
Monty
M
Mythen
Jan
J
Bakker
David
D
Bennett
Owen
O
Boyd
Andrew
A
Webb
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000758:Anesthesia; D002245:Carbon Dioxide / Q000032:analysis / Q000097:blood / Q000378:metabolism*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment
D002245:Carbon Dioxide