Prognostic value of gastric tonometry in patients with intestinal obstruction

Background and goals

Intestinal failure can be accompanied by intra-abdominal hypertension (IAH) [1]. Gastrointestinal ischaemia occurs particularly because of IAH [2]. The index of gut luminal PCO₂ referenced to arterial PCO₂ (PgCO₂–PaCO₂) reflects an adequacy of splanchnic tissue perfusion and is a predictor of any later complications [3].

Materials and methods

We studied 24 patients with diagnosis of intestinal obstruction. The survey patients were nearly homogeneous on age (average age 46 ± 4 years) and preoperative condition (APACHE II score 18 ± 1.8). One-half of patients were males. The same technique of anesthesia was carried out in all the patients. IAP and PgCO₂–PaCO₂ (kPa) were measured by TRIP NGS catheter and Tonocap monitor preoperatively. Cluster analysis was performed on the base of preoperative differences between IAP and PgCO₂–PaCO₂.

Results

On the results of cluster analysis, the patients were allocated into two groups. In 14 patients (group 1) the mean of pre-operative IAP was 1.82 ± 0.14 kPa. IAP was 0.41 ± 0.06 kPa in 10 patients of the second group (P < 0.05). Patients with higher IAP had 2.24 ± 0.42 PgCO₂–PaCO₂vs 1.49 ± 0.32 in group 2 (P < 0.05). Study of outcomes revealed that six patients of the group 1 had different serious complications and seven died. Eight patients from group 2 recovered without complications.

Conclusion

A higher level of PgCO₂–PaCO₂ because of increased IAP in patients with intestinal obstruction may have a prognostic value.