Gastrointestinal pHi as a predictor of morbidity

The clinical utility of pHi during the repair of abdominal aneurysm has been established in several studies. There is a significant correlation between decreases in pHi and the development of ischemic colitis in patients undergoing aortic reconstruction, in particular those with pHi values lower than 6.90. Decreases in pHi have also been associated with chronic gastric and mesenteric ischemia. Gastric pHi values less than 7.20 predict major complications after abdominal aortic surgery. Decreases in pHi have also been associated with bleeding from stress ulcers in intensive care unit (ICU) patients and in patients with chronic renal failure undergoing dialysis.

Measures of gastric pHi are predictive of weaning outcome from mechanical ventilation. Patients demonstrating decreases in pHi during the weaning process are likely to require mechanical ventilation. Also, there is an inverse association between changes in gastric pHi and the age of the transfused blood. Patients receiving blood stored for more than 15 days experience decreases in gastric mucosal pHi on a consistent basis, implying that aged red blood cells cause microcirculatory occlusion in some organs. Gastric tonometry also appears to have a useful role in assessing the viability of orthotopic liver transplants, with a greater incidence of major morbidity in patients with pHi < 7.32 at some point during the transplantation procedure.

Mucosal hypoperfusion, as defined by pHi < 7.32, has been associated with longer length of stay in the ICU, greater incidence of major complications, and greater mortality in patients undergoing elective major surgery (Myih§n,§D.d,Web.k„1994).

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