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Can gastric intramucosal pH (pHi) predict outcome of paediatric cardiac surgery?
T Bichel1, A Kalangos, J C Rouge
1Department of Anaesthesiology, University Hospital of Geneva, Switzerland.
Insights
Gastric tonometer monitoring of intramucosal pH (pHi) can predict postoperative complications in children after cardiac surgery. Lower pHi levels at surgery completion indicate higher risk for adverse outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Gastrointestinal Physiology
Background:
- Hypothermic cardiopulmonary bypass (CPB) is used in pediatric cardiac surgery.
- Monitoring splanchnic perfusion is crucial for predicting postoperative complications.
- Intramucosal pH (pHi) is a marker of splanchnic perfusion.
Purpose of the Study:
- To evaluate the use of gastric tonometer to estimate pHi intraoperatively.
- To determine if pHi monitoring can predict early postoperative complications in children undergoing cardiac surgery.
- To assess the relationship between pHi and adverse outcomes following CPB.
Main Methods:
- Forty-two children undergoing cardiac surgery with hypothermic CPB were studied.
- A gastric tonometer was used to measure intraoperative pHi.
- Children were divided into two groups: those with (Group C) and without (Group NC) early postoperative complications.
Main Results:
- Intramucosal acidosis was observed after aortic clamp removal and persisted post-CPB.
- Group C had significantly lower pHi at surgery completion (7.13 +/- 0.04) compared to Group NC (7.31 +/- 0.001).
- Longer bypass/aortic clamp times and lower core temperatures were noted in Group C.
Conclusions:
- Intramucosal acidosis during and after CPB is associated with postoperative complications.
- Lower intraoperative pHi levels are predictive of adverse outcomes in pediatric cardiac surgery patients.
- Gastric tonometry is a sensitive, minimally invasive monitoring tool for critically ill children, potentially improving predictive value with automated analysis.
Abstract:
In forty-two children undergoing cardiac surgery using hypothermic cardiopulmonary bypass (CPB), a gastric tonometer was used intraoperatively to estimate pHi, reflection of splanchnic perfusion. PHi monitoring was used to predict early postoperative complications. Intramucosal acidosis appeared after removal of the aortic clamp and remained after weaning of CPB. Fifteen children (group C) developed early postoperative life-threatening complications. Twenty-seven children (group NC) had no major complications. Retrospective data analysis showed a decrease of pHi during hypothermic CPB in the two groups but at completion of surgery, pHi was significantly lower in the group C (7.13 +/- 0.04 vs 7.31 +/- 0.001, P < 0.001). Bypass and aortic clamp times were also longer in group C and intraoperative core temperature lower. Continuous automated tonometer gas analysis appeared more accurate for the monitoring of acute haemodynamic and respiratory changes and should probably improve the predictive value of tonometry in the future. Tonometry is highly sensitive and represents an interesting and minimally invasive monitoring for critically ill children.