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Emergency cardiac mechanical assistance: place of mucosal gastric tonometry as prognostic indicator*

Published online by Cambridge University Press:  01 October 2007

P. Rosamel ,
C. Flamens ,
S. Paulus ,
M. Cannesson  and
O. Bastien
P. Rosamel
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
C. Flamens
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
S. Paulus
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
M. Cannesson
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
O. Bastien*
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
*
Correspondence to: Olivier Bastien, Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, 69394 Lyon, France. E-mail: [email protected]; Tel: +472118932; Fax: +472357314
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Summary

Background and objectives

The death of patients treated by ventricular assist device is usually related to multiorgan failure for which a disorder of splanchnic circulation is blamed. Gastric tonometry (measurement of gastric intra-mucosal pressure of CO2) has already been studied in many fields and especially in cardiac surgery. The aim of this study was to investigate the prognostic value of gastric tonometry monitoring after implantation of a ventricular assist device.

Methods

In this prospective study, all consecutive patients scheduled for a ventricular assist device were included. Gastric tonometry was added to standard monitoring. Data were collected (lactate, gastric CO2 (PgCO2) during cardiopulmonary bypass, at admission to ICU, 24 and 48 h later and when norepinephrine was stopped. Preoperative biologic and haemodynamic data were also collected. The primary endpoint was death.

Results

Fifty-six patients (50 men and 6 women) were included. In 91% of the cases, the mechanical assistance was biventricular. The objective of the assistance was a bridge to transplant in 93% (n = 27). Twenty-seven deaths (48%) occurred during the study, 59% (n = 16) of them took place before the cardiac transplantation (mean time = 18 ± 16 days after assist device insertion). Many factors were found to be associated with death: weight (P = 0.018), red cells administration (P = 0.025), length of surgery (P = 0.016), PgCO2 on admission to ICU (P = 0.040) and norepinephrine dose at 24 h.

Conclusions

Gastric tonometry has a prognostic value in the early postoperative hours after the implantation of a ventricular assist device.

Keywords

CARDIOPULMONARY BYPASSHEART-ASSIST DEVICESSTOMACH, gastric tonometryMORTALITYTRANSPLANTATION HEARTSPLANCHNIC CIRCULATION
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 10 , October 2007 , pp. 840 - 846
Copyright
Copyright © European Society of Anaesthesiology 2007

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Footnotes

*

This work was presented at the ‘46th Congrès de réanimation de langue française’ in Paris, April 2004 (R149) and at ‘Euroanesthesia’ Joint Meeting of European Society of Anaesthesiologists and European Acadamy of Anaesthesiology, Lisbon Portugal June 2004.

References

1.Davies, RA, Badovinac, K, Haddad, H et al. . Heart transplantation at the Ottawa Heart Institute: comparison with Canadian and international results. Artif Organs 2004; 28: 166–170.CrossRefGoogle ScholarPubMed
2.Fiddian Green, RG. Associations between intramucosal acidosis in the gut and organ failure. Crit Care Med 1993; 21: S103–S107.CrossRefGoogle ScholarPubMed
3.Scalia, S, Sharma, P, Rodriguez, J et al. . Decreased mesenteric blood flow in experimental multiple organ failure. J Surg Res 1992; 52: 1–5.Google Scholar
4.Nose, Y, Ohtsubo, S, Tayama, E. Therapeutic and physiological artificial heart: furure prospects. Artif Organs 1997; 21: 592–596.CrossRefGoogle Scholar
5.Minev, PA, El-Banayosy, A, Minami, K et al. . Differential indication for mechanical circulatory support following heart transplantation. Intensive Care Med 2001; 27: 11321–11327.CrossRefGoogle ScholarPubMed
6.Groeneveld, AB, Kolkman, JJ. Splanchnic tonometry: a review of physiology, methodology and clinical applications. J Crit Care 1994; 9: 198–210.CrossRefGoogle ScholarPubMed
7.Wippermann, CF, Schmid, FX, Kampmann, C et al. . Evaluation of gartric intramucosal pH during and after pediatric cardiac surgery. Eur J Cardiothorac Surg 1997; 12: 190–194.CrossRefGoogle Scholar
8.Lebuffe, G, Decoene, C, Pol, A et al. . Regional capnometry with air-automated tonometry detects circulatory failure earlier than conventional hemodynamics after cardiac surgery. Anesth Analg 1999; 89: 1084–1090.Google Scholar
9.Bellomo, R, Ronco, C, Kellum, JA et al. . Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8 4: R204–R212.Google Scholar
10.Reinhartz, O, Farrar, DJ, Hershon, JH et al. . Importance of preoperative liver function as a predictor of survival in patients supported with thoratec ventricular assist devices as a bridge to transplantation. J Thorac Cardiovasc Surg 1998; 116: 633–640.Google Scholar
11.Parsonnet, V, Dean, D, Bernstein, AD. A metod of uniform stratification of risk for evaluation the result of surgery in aquired adult heart disease. Circulation 1989; 79 (Suppl 1): 3–12.Google Scholar
12.Nashef, SAM, Roques, F, Michel, P et al. . European System for Cardiac Operative Risk Evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 15: 816–823.Google Scholar
13.Le Gall, JR, Lemeshow, S, Saulnier, F. A new simplified Acute Physiology Score (SAPS II) based on a European/North American Multicenter study. JAMA 1994; 271: 2957–2963.Google Scholar
14.Knaus, WA, Draper, EA, Wagner, DP et al. . APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–829.CrossRefGoogle ScholarPubMed
15.Aegerter, P, Boumendi, A, Retbi, A et al. . SAPS II revisited. Intensive Care Med 2005; 31: 416–423.CrossRefGoogle ScholarPubMed
16.Levy, B, Gawalkiewicz, P, Vallet, B et al. . Gastric capnometry with air-automated tonometry predicts outcomes in critically ill patients. Crit Care Med 2003; 31: 474–480.Google Scholar
17.Janssens, U, Graf, J, Koch, KC et al. . Gastric tonometry in patients with cardiogenic shock and intra-aortic balloon counter pulsation. Crit Care Med 2000; 28: 3449–3455.Google Scholar
18.Bernardin, G, Lucas, P, Hyvernat, H et al. . Influence of alveolar ventilation changes on calculated gastric intramucosal pH and gastric–arterial PCO2 difference. Intensive Care Med 1999; 25: 269–273.Google Scholar
19.Gutierrez, G, Brown, SD. Gastric tonometry: a new monotoring modality in the intensive care unit. J Intensive Care Med 1995; 10: 34–44.CrossRefGoogle Scholar
20.Poeze, M, Takala, J, Greve, JWM et al. . Pre-operative tonometry is predictive for mortality and morbidity in high-risk surgical patients. Intensive Care Med 2000; 26: 1272–1281.Google Scholar
21.Maynard, N, Bihari, D, Beale, R et al. . Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA 1993; 270: 1203–1210.CrossRefGoogle ScholarPubMed
22.Heinze, H, Heringlake, M, Schmucker, P et al. . Effects of intra-aortic balloon counterpulsation on parameters of tissue oxygenation. Eur J Anaesthesiol 2006; 23: 555–562.Google Scholar
23.Creteur, J, De Backer, D, Vincent, JL. Does gastric tonometry monitor splanchnic perfusion? Crit Care Med 1999; 27: 2480–2484.Google Scholar
24.Uusaro, A, Ruokonen, E, Takala, J. Gastric mucosal pH does not reflect changes in splanchnic blood flow after cardiac surgery. Br J Anaesth 1995; 74: 149–154.CrossRefGoogle Scholar
25.O’Malley, C, Frumento, RJ, Mets, B et al. . Abnormal gastric tonometric variables and vasoconstrictor used after left ventricular assist device insertion. Ann Thorac Surg 2003; 75: 1886–1891.Google Scholar
26.Silva, E, De Baker, D, Creteur, J et al. . Effects of vasoactive drugs on gastric intramucosal pH. Crit Care Med 1998; 26: 1749–1758.CrossRefGoogle ScholarPubMed
27.Gracin, N, Johnson, MR, Spokas, D et al. . The use of APACHE II scores to select candidates for left ventricular assist device placement. J Heart Lung Transplant 1998; 17: 1017–1023.Google Scholar
28.Janssens, U, Graf, J, Koch, KC et al. . Gastric tonometry: in vivo comparison of saline and air tonometry in patients with cardiogenic shock. Br J Anaesth 1998; 81: 676–680.Google Scholar