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ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

A European, Multicenter, Observational Study to Assess the Value of Gastric-to-End Tidal PCO₂ Difference in Predicting Postoperative Complications

Gilles Lebuffe, MD PhD^*, Benoît Vallet, MD PhD^*, Jukka Takala, MD PhD, Gary Hartstein, MD DSc, Maurice Lamy, MD, Monty Mythen, MD FRCA, Jan Bakker, MD PhD^||, David Bennett, MD FRCP^**, Owen Boyd, MD FRCA^**, and Andrew Webb, MD FRCP

*Department of Anesthesiology 2, CHU de Lille, Lille, France; Department of Intensive Care, Kuopio University Hospital, Kuopio, Finland; Department of Anesthesiology and Intensive Care, CHU de Liege, Liege, Belgium; Department of Intensive Care, UCL Hospitals Mortimer St, London; ||Department of Intensive Care, University Hospital, Apeldoorn, Netherlands; **Department of Intensive Care, St George’s Hospital, London, UK

Address correspondence and reprint requests to A. R. Webb, MD, FRCP, Medical Director, UCL Hospitals NHS Trust, John Astor House, Foley Street, London W1W 6DN, United Kingdom. Address email to a.webb{at}uclh.org

Automated online tonometry displays a rapid, semi-continuous measurement of gastric-to-endtidal carbon dioxide (Pr-etCO₂) as an index of gastrointestinal perfusion during surgery. Its use to predict postoperative outcome has not been studied in general surgery patients. We, therefore, studied ASA physical status III–IV patients operated on for elective surgery under general anesthesia and a planned duration of >2 h in a European, multicenter study. As each center was equipped with only 1 tonometric monitor, a randomization was performed if more than one patient was eligible the same day. Patients not monitored with tonometry were assessed only for follow-up. The main outcome measure was the assessment of postoperative functional recovery delay (FRD) on day 8. Among the 290 patients studied, 34% had FRD associated with a longer hospital stay. The most common FRDs were gastrointestinal (45%), infection (39%), and respiratory (35%). In those monitored with tonometry (n = 179), maximum Pr-etCO₂ proved to be the best predictor increasing the probability of FRD from 34% for all patients to 65% at a cut-off of 21 mm Hg (2.8kPa) (sensitivity 0.27, specificity 0.92, positive predictive value 64%, negative predictive value 70%). We conclude that intraoperative Pr-etCO₂ measurement may be a useful prognostic index of postoperative morbidity.

IMPLICATIONS: Gastric-to-end tidal partial pressure difference of carbon dioxide (Pr-etCO₂) is recognized as an index of gastrointestinal perfusion during surgery. In a high-risk surgical population with an expected duration of surgery of more than 2 h, this European, multicenter observational study suggests that automated semi-continuous monitoring of Pr-etCO₂ can be used as an intraoperative predictor of poor outcome.