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European Journal of Cardio-Thoracic Surgery, Vol 11, 1158-1162, Copyright © 1997 by European Association for Cardio-thoracic Surgery
R Mrozek, S Wos, R Bachowski, J Fryc, E Kucewicz, W Kruczak, M Deja and K Golba
OBJECTIVE: The aim of the study was to assess gastric mucosal pH during
certain parts of a major cardiac procedure (hypo- and normothermic), and
then throughout the first postoperative day. METHODS: Gastric mucosal pH
was measured using a tonometer, in 15 patients subjected to elective CABG
procedures. The patients were also assessed haemodynamically and serum
lactate concentrations were measured. RESULTS: It was found that
cardiopulmonary bypass did not suppress visceral perfusion. The most
critical was the period between 4th and 12th postbypass hour when a
tendency towards decreased cardiac output and oxygen delivery was noted. At
the same time oxygen consumption was increasing which resulted in
triggering of anaerobic metabolic pathways, that was mirrored by
significant rise in serum lactate levels. During this period of time the
lowest, although not critical levels of gastric mucosal pH were recorded,
suggesting a relative decrease in splanchnic perfusion. CONCLUSION:
Extracorporeal circulation does not significantly compromise splanchnic
perfusion. Tonometry is a valuable, non-invasive method of visceral
oxygenation monitoring. The first postoperative day is an especially
critical time for a cardiac patient--a frequent control of haemodynamic and
acid-base balance parameters is absolutely mandatory.
ARTICLES
Gastric tonometry as a method of visceral oxygenation monitoring in patients undergoing coronary revascularisation
IInd Department of Cardiac Surgery, Silesian Academy of Medicine, Katowice, Poland.
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