GASTRIC INTRAMUCOSAL PH-GUIDED THERAPY IN PATIENTS AFTER ELECTIVE REPAIR OF INFRARENAL ABDOMINAL ANEURYSMS - IS IT BENEFICIAL

Objective: To determine if gastric intramucosal pH (pHi)-guided therap y reduces the number of complications and length of stay in the intens ive care unit (ICU) or the hospital after elective repair of infrarena l abdominal aortic aneurysms. Design: Prospective, randomized study, S etting: Surgical intensive care Unit (SICU) of a University Hospital. Patients: Fifty-five consecutive patients randomized to group 1 (pHi-g uided therapy) or to group 2 (control). Interventions: Patients of gro up 1 with a pHi of lower than 7.32 were treated by means of a prospect ive protocol in order to increase their pHi to 7.32 or more. Measureme nts and results: pHi was determined in both groups on admission to the SICU and thereafter at 6-h intervals. In group 2, the treating physic ians were blinded for the pHi values. Complications, APACHE II scores, duration of endotracheal intubation, fluid and vasoactive drug treatm ent, treatment with vasoactive drugs, length of stay in the SICU and i n the hospital and hospital mortality were recorded. There were no dif ferences between groups in terms of the incidence of complications. We found no differences in APACHE II scores on admission, the duration o f intubation, SICU or hospital stay, or hospital mortality. In the two groups the incidence of pHi values lower than 7.32 on admission to th e SICU was comparable (41 % and 42 % in groups 1 and 2, respectively). Patients with pHi lower than 7.32 had more major complications during SICU slay (p < 0.05), and periods more than 10 h of persistently low pHi values (< 7.32) were associated with a higher incidence of SICU co mplications (p < 0.01). Conclusions: Low pHi values (< 7.32) and their persistence are predictors of major complications. Treatment to eleva te low pHi values does not improve postoperative outcome. Based on the se data, we cannot recommend the routine use of gastric tonometers for pHi-guided therapy in these patients. Further studies are warranted t o determine adequate treatment of low pHi values that results in benef icial effects on the patient's postoperative course and outcome.