European Journal of Cardio-Thoracic Surgery, Vol 12, 190-194, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Evaluation of gastric intramucosal pH during and after pediatric cardiac surgery
CF Wippermann, FX Schmid, C Kampmann, B Eberle, I Brandey, D Schranz and RG Huth
Department of Pediatrics, University of Mainz, Germany.
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.
