Gastric tonometry as a method of visceral oxygenation monitoring in patients undergoing coronary revascularisation

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Abstract
OBJECTIVE: The aim of the study was to assess gastric mucosal pH duringcertain parts of a major cardiac procedure (hypo- and normothermic), andthen throughout the first postoperative day. METHODS: Gastric mucosal pHwas measured using a tonometer, in 15 patients subjected to elective CABGprocedures. The patients were also assessed haemodynamically and serumlactate concentrations were measured. RESULTS: It was found thatcardiopulmonary bypass did not suppress visceral perfusion. The mostcritical was the period between 4th and 12th postbypass hour when atendency towards decreased cardiac output and oxygen delivery was noted. Atthe same time oxygen consumption was increasing which resulted intriggering of anaerobic metabolic pathways, that was mirrored bysignificant rise in serum lactate levels. During this period of time thelowest, although not critical levels of gastric mucosal pH were recorded,suggesting a relative decrease in splanchnic perfusion. CONCLUSION:Extracorporeal circulation does not significantly compromise splanchnicperfusion. Tonometry is a valuable, non-invasive method of visceraloxygenation monitoring. The first postoperative day is an especiallycritical time for a cardiac patient--a frequent control of haemodynamic andacid-base balance parameters is absolutely mandatory.

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