[en] Automated online tonometry displays a rapid, semicontinuous measurement of gastric-to-end tidal carbon dioxide (Pr-etCO(2)) as an index of gastrointestinal perfusion during surgery. Its use to predict postoperative outcome has not been studied in general surgery patients. We, therefore, studied ASA physical status III-IV patients operated on for elective surgery under general anesthesia and a planned duration of >2 h in a European, multicenter study. As each center was equipped with only 1 tonometric monitor, a randomization was performed if more than one patient was eligible the same day. Patients not monitored with tonometry were assessed only for follow-up. The main outcome measure was the assessment of postoperative functional recovery delay (FRD) on day 8. Among the 290 patients studied, 34% had FRD associated with a longer hospital stay. The most common FRDs were gastrointestinal (45%), infection (39%), and respiratory (35%). In those monitored with tonometry (n = 179), maximum Pr-etCO(2) proved to be the best predictor increasing the probability of FRD from 34% for all patients to 65% at a cut-off of 21 mm Hg (2.8 kPa) (sensitivity 0.27, specificity 0.92, positive predictive value 64%, negative predictive value 70%). We conclude that intraoperative Pr-etCO(2) measurement may be a useful prognostic index of postoperative morbidity.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Lebuffe, Gilles
Vallet, Benoît
Takala, Jukka
Hartstein, Gary ; Centre Hospitalier Universitaire de Liège - CHU > Urgences
Lamy, Maurice ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Bakker, Jan; University Hospital Apeldoorn, Netherlands > Department of Intensive Care
Bennett, David
Boyd, Owen
Webb, Andrew
Language :
English
Title :
A European, multicenter, observational study to assess the value of gastric-to-end tidal Pco(2) difference in predicting postoperative complications
Publication date :
July 2004
Journal title :
Anesthesia and Analgesia
ISSN :
0003-2999
eISSN :
1526-7598
Publisher :
Lippincott Williams & Wilkins, Philadelphia, United States - Pennsylvania
Hanley B, Truesdale A, King A et al. Involving consumers in designing, conducting, and interpreting randomised controlled trials: questionnaire survey. BMJ 2001;322:519-23.
Bellomo R, Goldsmith D, Russell S, Uchino S. Postoperative serious adverse events in a teaching hospital: a prospective study. Med J Aust 2002;176:216-8.
Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001;322:517-9.
Bennett-Guerrero E, Welsby I, Dunn TJ, et al. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery. Anesth Analg 1999;89:514-9.
Older P, Smith R, Courtney P, Hone R. Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest 1993;104:701-4.
Mythen MG, Webb AR. Intraoperative gut mucosal hypoperfusion is associated with increased postoperative complications and cost. Intensive Care Med 1994;20:99-104.
Mythen MG, Webb AR. The role of gut mucosal hypoperfusion in the pathogenesis of postoperative organ dysfunction. Intensive Care Med 1994;20:203-9.
Baue AE. The role of the gut in the development of multiple organ dysfunction in cardiothoracic patients. Ann Thorac Surg 1993;55:822-9.
Soong CV, Halliday ML Barclay GR, et al. Intramucosal acidosis and systemic host responses in abdominal aortic aneurysm surgery. Crit Care Med 1997;25:1472-9.
Bennett-Guerrero E, Panah MH, Bodian CA, et al. Automated detection of gastric luminal partial pressure of carbon dioxide during cardiovascular surgery using the Tonocap. Anesthesiology 2000;92:38-45.
Uusaro A, Lahtinen P, Parviainen L Takala J. Gastric mucosal end-tidal PCO2 difference as a continuous indicator of splanchnic perfusion. Br J Anaesth 2000;85:563-9.
Lebuffe G, Onimus T, Vallet B. Gastric mucosal-to-end-tidal PCO2 difference during major abdominal surgery: influence of the arterial-to-end- tidal PCO2 difference? Eur J Anaesthesiol 2003;20:147-52.
Lebuffe G, Decoene C, Pol A, et al. Regional capnometry with air-automated tonometry detects circulatory failure earlier than conventional hemodynamics after cardiac surgery. Anesth Analg 1999;89:1084-90.
Shoemaker WC, Appel PL, Kram HB, et al. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988;94:1176-86.
Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg 1991;78:355-60.
McNeil BJ, Keller E, Adelstein SJ. Primer on certain elements of medical decision making. N Engl J Med 1975;293:211-5.
Metz CE, Goodenough DJ, Rossmann K. Evaluation of receiver operating characteristic curve data in terms of information theory, with applications in radiography. Radiology 1973;109:297-303.
Levy B, Gawalkiewicz P, Vallet B, et al. Gastric capnometry with air-automated tonometry predicts outcome in critically ill patients. Crit Care Med 2003;31:474-80.
Schlichtig R, Bowles SA. Distinguishing between aerobic and anaerobic appearance of dissolved CO2 in intestine during low flow. J Appl Physiol 1994;76:2443-51.
Hamilton-Davies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intensive Care Med 1997;23:276-81.
Chang MC, Cheatham ML, Nelson LD, et al. Gastric tonometry supplements information provided by systemic indicators of oxygen transport. J Trauma 1994;37:488-94.
