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The death of patients treated by ventricular assist device is usually related to multiorgan failure for which a disorder of splanchnic circulation is blamed. Gastric tonometry (measurement of gastric intra-mucosal pressure of CO2) has already been studied in many fields and especially in cardiac surgery. The aim of this study was to investigate the prognostic value of gastric tonometry monitoring after implantation of a ventricular assist device.
In this prospective study, all consecutive patients scheduled for a ventricular assist device were included. Gastric tonometry was added to standard monitoring. Data were collected (lactate, gastric CO2 (PgCO2) during cardiopulmonary bypass, at admission to ICU, 24 and 48 h later and when norepinephrine was stopped. Preoperative biologic and haemodynamic data were also collected. The primary endpoint was death.
Fifty-six patients (50 men and 6 women) were included. In 91% of the cases, the mechanical assistance was biventricular. The objective of the assistance was a bridge to transplant in 93% (n = 27). Twenty-seven deaths (48%) occurred during the study, 59% (n = 16) of them took place before the cardiac transplantation (mean time = 18 ± 16 days after assist device insertion). Many factors were found to be associated with death: weight (P = 0.018), red cells administration (P = 0.025), length of surgery (P = 0.016), PgCO2 on admission to ICU (P = 0.040) and norepinephrine dose at 24 h.
Gastric tonometry has a prognostic value in the early postoperative hours after the implantation of a ventricular assist device.
Arterial pulse waveform analysis has been proposed for cardiac output (CO)
determination and monitoring without calibration or thermodilution
(FloTrac™/Vigileo™; Edwards Lifesciences, Irvine, CA,
USA). The accuracy and clinical applicability of this technology has not
been fully evaluated. We designed this prospective study to compare the
accuracy of the FloTrac™ system (COFT) vs. pulmonary
artery catheter standard bolus thermodilution (COPAC) in patients
undergoing coronary artery bypass grafting.
We studied 11 patients referred for coronary artery bypass grafting.
COFT and COPAC were determined at six time points
in the operating room including before and 5 min after volume expansion (500
mL 6% hetastarch). Measurements were performed on arrival in the intensive
care unit and every 4 h afterwards. Bland–Altman analysis was
used to assess the agreement between COFT and
COPAC ranged from 2.0 to 7.6 L min−1 and
COFT ranged from 1.9 to 8.2 L min−1.
There was a significant relationship between COPAC and
COFT (r = 0.662; P < 0.001). Agreement between
COPAC and COFT was −0.26 ±
0.87 L min−1. Volume expansion induced a significant
increase in both COPAC and COFT (from 3.4 ±
0.8 to 4.4 ± 1.0 L min−1; P < 0.001 and from 3.9 ±
1.2 to 5.0 ± 1.1 L min−1; P < 0.001, respectively) and there
was a significant relationship between percent change in COPAC
and COFT following volume expansion (r = 0.722; P = 0.01).
We found clinically acceptable agreement between COFT and
COPAC in this setting. This new device has potential clinical
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