Related Experiment Videos
Abnormal gastric tonometric variables and vasoconstrictor use after left ventricular assist device insertion
Catherine M N O'Malley1, Robert J Frumento, Berend Mets
1Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. co2001@columbia.edu
The Annals of Thoracic Surgery
|June 26, 2003
Summary
Left ventricular assist device (LVAD) implantation can lead to abnormal gastric tonometry, indicating splanchnic ischemia. This gastric ischemia is linked to increased vasoconstrictor use and worse patient outcomes.
Area of Science:
- Cardiology
- Gastroenterology
- Critical Care Medicine
Background:
- Abnormal gastric tonometric variables, indicative of splanchnic ischemia, affect roughly 50% of patients post-cardiac surgery.
- These abnormal variables are linked to increased postoperative morbidity.
Purpose of the Study:
- To investigate if gastric tonometric variables worsen after left ventricular assist device (LVAD) insertion.
- To explore the relationship between abnormal gastric tonometry and the use of vasoconstrictors.
Main Methods:
- A prospective, observational study involving 19 patients undergoing LVAD implantation.
- Automated air tonometry was used to measure the gastric-arterial partial pressure of carbon dioxide (CO2 gap) at five perioperative time points.
Main Results:
- Systemic blood flow significantly increased post-LVAD implantation (2.9 L x min(-1) x m(-2) vs. 1.9 L x min(-1) x m(-2)).
- Gastric tonometry became abnormal in 90% of patients (CO2 gap increased from 4 mm Hg to 24 mm Hg).
- Elevated CO2 gaps correlated with higher doses of norepinephrine and vasopressin, and with longer ICU stays and higher multiple organ dysfunction scores.
Conclusions:
- Abnormal gastric tonometric variables developed post-LVAD implantation despite increased systemic blood flow.
- These findings suggest gastric ischemia can occur independently of systemic blood flow changes.
- The results support a potential role for vasoconstrictors in causing splanchnic ischemia in LVAD patients.