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Evaluation of gastric intramucosal pH during and after pediatric cardiac surgery
C F Wippermann1, F X Schmid, C Kampmann
1Department of Pediatrics, University of Mainz, Germany.
Insights
Intramucosal pH (pHi) monitoring in pediatric cardiac surgery patients showed high rates of low values post-ICU arrival but did not predict organ dysfunction. Current tonometry equipment is not recommended for managing these patients.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Gastroenterology
Background:
- Intramucosal pH (pHi) monitoring is used in adults to detect postoperative complications.
- Its utility in pediatric patients undergoing cardiac surgery is not well-established.
Purpose of the Study:
- To evaluate the use of intramucosal pH (pHi) monitoring in pediatric patients during and after cardiac surgery.
- To determine if pHi can predict postoperative complications in this population.
Main Methods:
- Thirty-five pediatric patients (5 days to 15 years) were studied.
- Intramucosal pH (pHi) was measured at multiple time points: before cardiopulmonary bypass (CPB), during CPB, and up to 72 hours post-surgery.
- Correlations with arterial pH, temperature, lactate, and central venous pressure were analyzed.
Main Results:
- No complications arose from tonometer use.
- Pathologically low pHi (<7.32) was frequent at ICU arrival (83%) and 48 hours post-op (18%).
- Lower pHi values correlated with arterial pH, temperature difference, lactate, and CVP. Patients post-Fontan procedure had lower pHi.
- pHi did not differentiate patients with signs of organ dysfunction.
Conclusions:
- Current tonometry equipment is not recommended for managing pediatric cardiac surgery patients.
- Tonometry, as a semi-invasive method, warrants further investigation in pediatric critical care.
Objectives:
In adult patients, intramucosal pH (pHi) has been advocated to detect postoperative complications. The purpose of our study was to evaluate this technique in pediatric patients during and after cardiac surgery.
Methods:
Thirty-five infants (age: 5 days to 15 years, median 1.8 years; and weight: 3.2-32 kg, median 9.8 kg) were studied. pHi was measured before cardiopulmonary bypass (CPB), after 30 min of CPB, prior to weaning off CPB, at intensive care unit arrival, and 6, 12, 24, 48 and 72 h after surgery.
Results:
There were no complications related to the tonometer. A pathologically low pHi < 7.32 was found during surgery in less than 17%, at intensive care unit arrival in 83% and after 48 h in 18%. pHi values were lower (P < 0.05) at intensive care unit arrival (7.25 +/- 0.08) and after 6 h (7.28 +/- 0.09) than afterwards. pHi correlated with arterial pH (r = 0.66), central-peripheral temperature difference (r = -0.36), lactate (r = -0.32) and central venous pressure (r = -0.21). Patients after a Fontan procedure had postoperatively a lower pHi than after other operations (P < 0.05). None of the patients died or developed organ failure. Six patients had signs of organ dysfunction. Their pHi (median 7.23, range 7.14-7.28) could not differentiate them from the other patients.
Conclusions:
With current equipment, tonometry cannot be recommended for the management of pediatric patients after cardiac surgery. However, as a semi-invasive method tonometry deserves further evaluation.