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The effect of cardiopulmonary bypass on gastric and colonic mucosal perfusion: a tonometric assessment

Cardiothoracic Unit, Department of Surgery, Hammersmith Hospital, Royal Postgraduate Medical School, London

C.T. Bowles

Cardiac Surgical Unit, Harefield Hospital, Middlesex

A. Siddiqui

Cardiac Surgical Unit, Harefield Hospital, Middlesex

A. Khaghani

Cardiac Surgical Unit, Harefield Hospital, Middlesex

B.E. Keogh

Cardiothoracic Unit, Department of Surgery, Hammersmith Hospital, Royal Postgraduate Medical School, London

G. Wright

Department of Anaesthetics, Harefield Hospital, Middlesex

M.H. Yacoub

Cardiac Surgical Unit, Harefield Hospital, Middlesex

K.M. Taylor

Cardiothoracic Unit. Department of Surgery, Hammersmith Hospital, Royal Postgraduate Medical School, London

In a study to assess the potential effect of nonpulsatile hypothermic cardiopulmonary bypass (CPB), intramucosal pH (pHi) of the gastric and colonic mucosae was determined by tonometry (n = 8). During the hypothermic phase of CPB, gastric and colonic pHi did not change significantly. Forty minutes after the start of rewarming, despite increases in the cardiac index and mean arterial blood pressure, gastric pHi fell from 7.53 ± 0.02 to 7.31 ± 0.03 (p = 0.017) and colonic pHi fell from 7.50 ± 0.02 to 7.32 ± 0.03 (p = 0.028). Forty minutes after the end of CPB both the colonic (p = 0.017) and gastric (p = 0.046) pHi remained depressed below pre-CPB values. The difference in the arterial (pHa) and the gastric mucosal pH changed from -0.097 before CPB to 0.016, 40 minutes after the end of CPB (p = 0.027). This alteration in the pHa-pHi underlines the importance of measuring intramucosal pH by tonometry, since the pHa and pHi may move in opposite directions during episodes of haemodynamic stress. Both the gastric and colonic pHi were found to have a linear correlation with the pHa, although changes in the gastric pHi (r = 0.41, p = 0.018) were more strongly correlated with the pHa than the colonic pHi (r = 0.23, p = 0.19) in the rewarming phase of CPB and the immediate post-CPB period when there was a tendency towards intramucosal acidosis. The development of intramucosal acidosis in the rewarming and immediate post-CPB phases following hypothermic nonpulsatile CPB may impair the gut barrier and predispose patients to the absorption of luminal toxins.

Perfusion, Vol. 9, No. 2, 101-108 (1994)
DOI: 10.1177/026765919400900204


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