Objective: To examine the usefulness of gastric intramucosal pH (pHi) to predict adverse events during the postoperative period after cardiac surgery in pediatric patients.
Design: Prospective, observational clinical study.
Setting: Multidisciplinary pediatric intensive care unit, university hospital.
Patients: A total of 70 patients who had elective cardiac surgery and cardiopulmonary bypass; mean age, 4.0 yrs.
Interventions: Gastric tonometry.
Measurements and main results: In all cases, the pHi was determined within the first 2 hrs and again within the first 12 hrs of the postoperative period after cardiac surgery. The following adverse events were considered: mortality, multiple organ failure (MOF), and infectious complications. Patients were divided into three groups: Group A, patients having the two pHi measurements < or =7.32 (n = 15); Group B, patients having the two pHi determinations >7.32 (n = 28); and Group C, patients having one pHi determination < or =7.32 and the other >7.32 (n = 27). Of the total sample, 5 (7.1%) patients died; 4 (5.7%) had MOF, and 13 (18.5%) had infectious complications. When the rate of adverse events was analyzed in the three groups, significant differences were found in mortality (p < .035) and MOF (p < .029). This was not the case for infectious complications (p = .071). In Group A, three patients died and three had MOF. The standardized chi-square values were 1.87 and 2.31 respectively, causing the authors to consider that this group accounted for the differences found in the global analysis.
Conclusions: Two pHi determinations < or =7.32, one at admission and one at 12 hrs of the postoperative period after cardiac surgery and cardiopulmonary bypass, were associated with a higher rate of mortality and MOF, but not with a higher rate of infectious complications. It is not yet possible to recommend the use of this finding as a treatment objective to guide hemodynamic optimization in this group of patients.