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[Gastric pH changes during and after extracorporeal circulation. What is its clinical meaning?]
A Paccagnella1, M Calò, M Baiocchi
1II Servizio di Anestesia e Rianimazione, Ospedale S. Maria de' Battuti, Treviso.
Objective:
To determine the relationship between gastric pH (pHm) and several other indices of blood perfusion in patients undergoing cardiopulmonary bypass (CPB). To evaluate the importance of pHm as a prognostic index for elective cardiac surgery.
Design:
Prospectives study.
Setting:
Cardiac surgery ICU of a Regional Hospital in Italy.
Patients:
Nineteen patients were sequentially studies in a 4-month period.
Method:
Before anesthetic induction, a pH probe incorporated in the tip of a nasogastric tube (GrapHprobe SH, GrapHometer, Zinetics Medical, USA) was inserted in the stomach. Results, collected during the CPB and in the postoperative period until 1 hour after extubation, were compared to the peripheral tissue perfusion and oxygenation data (transcutaneous: PtcO2), hemodynamic variations (Swan-Ganz catheter), pharyngeal temperature, and blood gases.
Results:
No significant variations of pHm were reported during the study. Significant relations were found only after surgery between pHm and PaO2 (p < 0.001), hemoglobin (p < 0.001), and blood pH (p < 0.05). No statistical correlations were reported between pHm and hemodynamic variations.
Conclusions:
Although a significant variation of peripheral and pulmonary vascular resistance and transcutaneous oxygenation was reported throughout the study, no correlations were found to pHm. At present it is not possible to confirm the importance of pHm as a prognostic index for elective cardiac patients, even though it is necessary to examine whether the additional data of pHm variation could be considered a true marker of visceral perfusion.