Predictive value of the stomach wall pH for complications after cardiac operations

Fiddian-Green, Richard G.; Baker, Stephen P.

doi:10.1097/00003246-198702000-00015

Cited by 356 publications

(109 citation statements)

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“…1 4 Further, the lower limit of normal gastric mucosal pH was 7.32. 7,15 Thus, the PCO 2 gap and gastric mucosal pH values of our patients remained within these normal ranges. Furthermore, the gap between regional and arterial PCO 2 did not change, strongly suggesting the unharmful nature of the surgical procedure.…”

Section: Discussionsupporting

confidence: 55%

“…6 Gastrointestinal saline tonometry was introduced in the late 1980s. 7 The method has been improved to a clinically feasible on-line monitoring of splanchnic perfusion by new automated air tonometry. 8 Results of tonometric measurements during laparoscopic cholecystectomy have been conflicting, varying from reports of splanchnic ischemia 9 or deterioration 10 to no detectable changes.…”

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confidence: 99%

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Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels

Mäkinen

Heinonen

Klemola

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: Pneumoperitoneum can cause disturbances in acid-base balance and splanchnic perfusion. We studied the effect of ventilation on acid-base balance and gastric mucosal tonometric values in patients undergoing laparoscopic cholecystectomy. Methods: Twenty-four patients (ASA I-II) were randomly allocated into two groups. In the fixed ventilation group, ventilation was constant allowing free increase in PCO 2 , while in the constant CO 2 group end-tidal PCO 2 was fixed with ventilatory adjustment. Intraabdominal pressure was limited to 12 mmHg. Arterial acid-base balance, automated air tonometric variables and gastric mucosal to arterial PCO 2 gap were determined frequently from anesthesia induction until three hours postoperatively. Results: During pneumoperitoneum, in the fixed ventilation group arterial PCO 2 changed from 5.0 ± 0.2 to 6.6 ± 0.4 kPa and pH from 7.43 ± 0.03 to 7.33 ± 0.04, tonometric PCO 2 from 5.1 ± 0.5 to 6.9 ± 0.4 and pH from 7.44 ± 0.04 to 7.33 ± 0.04. In the constant CO 2 group these variables remained at control levels (P < 0.01 between groups). The PCO 2 gap remained unchanged without any differences between the groups. In the recovery room all measured variables were within normal range in both groups.Conclusion: Despite inter-group differences in arterial and tonometric PCO 2 and pH values during CO 2 pneumoperitoneum, the patients did not develop splanchnic hypoperfusion detectable by air tonometric method, as indicated by normal PCO 2 gap in both groups throughout the study.Objectif : Le pneumopéritoine peut causer des perturbations de l'équilibre acido-basique et de l'irrigation splanchnique. Nous avons étudié l'effet de la ventilation sur l'équilibre acido-basique et la tonométrie de la muqueuse gastrique chez des patients devant subir une cholécystectomie laparoscopique.Méthode : Vingt-quatre patients (ASA I-II) ont été répartis au hasard en deux groupes. Dans le premier groupe, à ventilation fixe, la ventilation était constante et permettait une augmentation libre de la PCO 2 , tandis que dans le second groupe, au CO 2 constant, la PCO 2 de fin d'expiration était fixe par ventilation adaptée. La pression intraabdominale était limitée à 12 mmHg. L'équilibre acido-basique artériel, les variables automatisées de la tonométrie gazeuse de la muqueuse gastrique, pour calculer l'écart de PCO 2 artériel, ont été déterminés fréquemment depuis l'induction de l'anesthésie jusqu'à trois heures après l'opération.Résultats : Pendant le pneumopéritoine, dans le groupe à ventilation fixe, la PCO 2 artérielle est passée de 5,0 ± 0,2 à 6,6 ± 0,4 kPa et le pH de 7,43 ± 0,03 à 7,33 ± 0,04; la PCO 2 tonométrique est passée de 5,1 ± 0,5 à 6,9 ± 0,4 et le pH de 7,44 ± 0,04 à 7,33 ± 0,04. Dans le groupe au CO 2 constant, ces variables ont conservé les valeurs témoins (P < 0,01 intergroupe). L'écart de PCO 2 est demeuré inchangé et sans différence intergroupe. Dans la salle de réveil, toutes les variables mesurées étaient dans les limites de la normale pour les patients des deux groupes.Conclusion : M...

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Section: Discussionsupporting

confidence: 55%

mentioning

confidence: 99%

Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels

Mäkinen

Heinonen

Klemola

et al. 2001

Can J Anesth/J Can Anesth

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“…The pHi and gpCO 2 values were measured preoperatively and at the 24 th postoperative hour using GT. The cut-off value of gastric pHi was obtained from previous studies (12). At the same time, arterial blood gas and blood lactate values were studied.…”

Section: Methodsmentioning

confidence: 99%

The effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained

Öz

Akyüz

Emek

et al. 2015

UCD

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Objective: The aim of the study was to evaluate the effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained. Material and Methods:The gastric pH (pHi) and gastric CO 2 (gpCO 2 ) were measured with gastric tonometry catheter, preoperatively and postoperatively at 24 hours, in patients with suspicion of acute mesenteric ischemia. Simultaneous evaluation of blood gases and blood lactate levels were performed. Patients were divided into two groups after surgery. Group 1 included patients with mesenteric ischemia, and Group 2 consisted of patients without mesenteric ischemia.Results: Forty-two patients (26 males, 16 females) were evaluated. The mean age was 61.4±13.3 years. There was no significant difference between the groups in terms of demographic factors and co-morbid diseases. There were no significant differences between groups in terms of pHi and gpCO 2 levels (7.24±0.2 and -3±12.0 in Group 1, 7.18±0.06 and -3±1.9 in Group 2, respectively), intra-abdominal pressure, lactate levels, and survival. Among all the study parameters, only arterial pH had statistical significance in the diagnosis of acute mesenteric ischemia (7.23±0.21 versus 7.35±0.07 for Groups 1 and 2, respectively,) (p<0.05). Conclusion:Gastric tonometry is not a useful method in the early diagnosis of acute mesenteric ischemia.

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“…4 Clinical monitoring of splanchnic organs has been proposed to be a specific indicator of shock and sepsis. [5][6][7] Ischemic damage of the gastrointestinal tissue is characterized by alterations in cellular function and energy metabolism, which are caused by an inadequate supply and limited consumption of oxygen, insufficient membrane permeability, and a reduction of extracellular volume. Cellular acidosis due to ischemia is caused by the accumulation of lactic and carbonic acids that produce an increase of hydrogen ions and intracellular osmolality, followed by cellular edema and phospholipids synthesis inhibition, which cause cellular membrane damage.…”

Section: Introduction Splanchnic Hypoperfusion and Ischemia In The Crmentioning

confidence: 99%

Gastrointestinal ischemia monitoring through impedance spectroscopy as a tool for the management of the critically ill

Beltran¹,

Sacristán

2015

Exp Biol Med (Maywood)

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Impedance spectroscopy (IS) has been proposed as a tool for monitoring mucosal tissue ischemia and damage in the gut of critically ill patients resulting from shock and hypoperfusion. A specific device and system have been developed and tested for this specific application over the past 12 years by our research group. This paper reviews previously published studies as well as unpublished experimental results, and puts the whole in context and perspective to help understand this technology. Results presented include summaries of gastric reactance measurement understanding, in vivo measurements in animal models, clinical significance of the measurement, and future perspectives of clinical use of this technology. All of the experimental work done to date has been designed to determine the evolving device prototypes' performance and limitations from an instrumentation point of view. Although there are still questions to be answered with regard to the IS measurement, we conclude that we have reached enough confidence in the measurement and the device's performance and safety to begin clinically oriented research to learn how this technology may be useful in the diagnosis and management of different populations of the critically ill.

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Predictive value of the stomach wall pH for complications after cardiac operations

Cited by 356 publications

References 0 publications

Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels

Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels

The effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained

Gastrointestinal ischemia monitoring through impedance spectroscopy as a tool for the management of the critically ill

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