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Gastric mucosal-to-end-tidal PCO2 difference during major abdominal surgery: influence of the arterial-to-end-tidal PCO2 difference?

Published online by Cambridge University Press:  02 June 2005

G. Lebuffe ,
T. Onimus  and
B. Vallet
G. Lebuffe
Affiliation:
Hôpital Claude Huriez, Département d'anesthésie-réanimation II, Centre Hospitalier Universitaire, Lille, France
T. Onimus
Affiliation:
Hôpital Albert Calmette, Service d'Urgence Respiratoire, Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Universitaire, Lille, France
B. Vallet
Affiliation:
Hôpital Claude Huriez, Département d'anesthésie-réanimation II, Centre Hospitalier Universitaire, Lille, France
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Abstract

Summary

Background and objective: Because gastric mucosal PCO2 must be referenced to arterial values via a gastric-to-arterial PCO2 gap (Pg–aCO2), the gastric-to-end-tidal PCO2 difference (Pg–etCO2) may be proposed as a surrogate method to monitor Pg–aCO2. However, the influence of arterial-to-end-tidal PCO2 (Pa–etCO2) on its value remains unknown. Pa–etCO2 may be enhanced by a low cardiac output and subsequent reduced perfusion of the lungs. This study was designed to compare such gaps observed during abdominal surgery in patients with or without preoperative cardiac dysfunction.

Methods: Haemodynamic, metabolic and tonometric variables were measured in seven patients with Crohn's disease and in five patients with chronic heart failure scheduled for abdominal surgery. Data were collected before skin incision (T0); at extractor placement (T1), 30 (T2) and 60 (T3) min later; at organ extraction (T4), 30 (T5) and 60 (T6) min later, and at the end of surgery (T7).

Results: Gradients appeared larger in the cardiac group. The difference was significant for Pg–etCO2 during the whole study period, while it was only reached at T1–T2 for Pa–etCO2 and at T5–T6 for Pg–aCO2. Gaps did not change significantly over the peroperative time points in either group. No major haemodynamic variations were registered in either group.

Conclusions: In patients with preoperative chronic heart failure, Pg–etCO2 remained constant throughout a major general surgical procedure and was only moderately influenced by the Pa–etCO2 gap. In these patients, Pg–etCO2 may be used as a reliable index of gastrointestinal perfusion after control of PaCO2.

Keywords

ANAESTHESIA, GENERALBLOOD GAS ANALYSIS, BLOOD GAS MONITORING, gastric tonometryHAEMODYNAMICS, regional blood flow, stomach
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 2 , February 2003 , pp. 147 - 152
Copyright
2003 European Society of Anaesthesiology

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References

Ohri SK, Bowles CW, Mathie RT, Lawrence DR, Keogh BE, Taylor KM. Effect of cardiopulmonary bypass perfusion protocols on gut tissue oxygenation and blood flow. Ann Thorac Surg 1997; 64: 163–170.Google Scholar
Kreimeier U. Pathophysiology of fluid imbalance. Crit Care 2000; 4: S3–S7.Google Scholar
Marshall JC, Christou NV, Horn R, Meakins J. The microbiology of multiple organ failure. Arch Surg 1988; 123: 309–315.Google Scholar
Hassoun HT, Kone BC, Mercer DW, Moody FG, Weisbrodt NW, Moore FA. Post-injury multiple organ failure: the role of the gut. Shock 2001; 15: 1–10.Google Scholar
Mythen MG, Webb AR. Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complications and cost. Int Care Med 1994; 20: 99–104.Google Scholar
Mythen M, Faehnrich J. Monitoring gut perfusion. In: Rombeau JL, Takala J, eds. Gut Dysfunction in Critical Illness.Berlin, Germany: Springer, 1997: 246–263.
Creteur J, De Backer D, Vincent JL. Monitoring gastric mucosal carbon dioxide pressure using gas tonometry. Anesthesiology 1997; 87: 504–510.Google Scholar
Vallet B. Regional capnometry. In: Vincent JL, ed. Yearbook of Intensive Care and Emergency Medicine.Berlin, Germany: Springer, 1997: 669–676.
Guzman JA, Lacoma JF, Kruse JA. Relationship between systemic oxygen supply dependency and gastric intramucosal PCO2 during progressive haemorrhage. J Trauma 1998; 44: 696–700.Google Scholar
Bernardin G, Lucas P, Hyvernat H, Deloffre P, Mattei M. Influence of alveolar ventilation changes on calculated gastric intramucosal pH and gastric-arterial PCO2 difference. Int Care Med 1999; 25: 269–273.Google Scholar
Russell JA. Gastric tonometry: does it work? Int Care Med 1997; 23: 3–6.Google Scholar
Chapman MV, Mythen MG, Webb AR, Vincent JL. Report from the meeting: Gastrointestinal tonometry: state of the art. Int Care Med 2000; 26: 613–622.Google Scholar
Lebuffe G, Decoene C, Pol A, Prat A, Vallet B. Regional capnometry with air-automated tonometry detects circulatory failure earlier than conventional hemodynamics after cardiac surgery. Anesth Analg 1999; 89: 1084–1090.Google Scholar
Wasserman K, Zhang YY, Gitt A, et al. Lung function and exercise gas exchange in chronic heart failure. Circulation 1997; 96: 2221–2227.Google Scholar
Tanabe Y, Hosaka Y, Ito M, Ito E, Suzuki K. Significance of end-tidal PCO2 response to exercise and its relation to functional capacity in patients with chronic heart failure. Chest 2001; 119: 811–817.Google Scholar
Kolkman JJ, Steverink PJGM, Groeneveld ABJ, Meuwissen SGM. Characteristics of time-dependent PCO2 tonometry in the normal human stomach. Br J Anaesth 1998; 81: 669–675.Google Scholar
Hamilton-Davies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Int Care Med 1997; 23: 276–281.Google Scholar
Schlichtig R, Bowles A. Distinguishing between aerobic and anaerobic appearance of dissolved CO2 in intestine during low flow. J Appl Physiol 1994; 76: 2443–2451.Google Scholar
Guzman JA, Lacoma FJ, Kruse JA. Relationship between systemic oxygen supply dependency and gastric intramucosal PCO2 during progressive hemorrhage. J Trauma 1998; 44: 696–700.Google Scholar