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• W2024281413 abstract "A reply EDITOR: We thank Dr Björck for his interest in our work [1] and for giving us the opportunity both to re-emphasize points made in our paper and to correct a reference mistake in the published version. We first apologize to Dr Björck for the reference error in the third paragraph of the discussion part where reference 10 should in fact be reference 19. Furthermore, we share Dr Björck's point of view that sigmoid tonometry monitoring in surgery for aortic aneurysm is best indicated in high-risk patients. In our study, patients included were at high risk with a Parsonnet score ≥4; six of our patients had a combined history of myocardial necrosis and severe chronic obstructive bronchopulmonary disease. The surgical procedure was also particularly difficult as attested by long surgical and clamping times. All these factors explain our high frequency of ischaemic colitis. These patients were selected voluntarily because the main objective of our study was to compare the sigmoid-to-arterial PCO2 gap with the mucosal aspect as assessed by colonoscopy, which is the reference diagnostic tool of ischaemic colitis. It was interesting to observe that patients with the highest PCO2 gap were those who developed the most severe postoperative ischaemic colitis. However, our study was not powerful enough to determine the limits of the PCO2 gap, thus not allowing us to distinguish a normal from an ischaemic intestinal mucosa. In our practice, we do not argue about the sole regional PCO2 but we compare it with arterial PCO2 since tissue PCO2 concentration is dependent on the PCO2 of the perfusing arterial blood. A regional-to-arterial PCO2 gap >4 kPa provides sufficient information suggesting bowel mucosal low flow associated with O2 uptake-to-supply dependency [2], a state known as dysoxia. In this study [1], endoscopically proven ischaemic colitis was shown for PCO2 gaps >6-8 kPa. This leads us to think that a sigmoid PCO2 >15 kPa, an upper technical limit with the Tonocap® as emphasized by Björck [3], is so high, that the intestinal mucosa obviously suffers from dysoxia, preventing any doubt or interpretation. We emphasize furthermore that in our hands PrCO2 rarely goes beyond 10-12 kPa [1]. We would like to point out that trends - rather than absolute PCO2 or pHi - much better reflect any underlying regional PCO2. Therefore, a high PCO2 gap, which persists after aortic declamping without any improvement in the initial postoperative period, will alert the clinicians to perform a colonoscopy. For this reason, automatic measurements of PCO2 are certainly of great help. We agree with Dr Björck that sigmoid capnometry in aortic surgery will be mostly valuable in high-risk patients, whereas further prospective and multicentre studies are required to determine the lower limit of the PCO2 gap associated with colitis dysoxia and the influence of therapeutic correction of a high PCO2 gap on the incidence of bowel injury. G. Lebuffe B. Vallet Department of Anaesthesia and Intensive Care Medicine; University Hospital; Claude Huriez Hospital; Lille, France" @default.
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• W2024281413 date "2002-10-01" @default.
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• W2024281413 title "Sigmoid capnometry in abdominal aortic aneurysm surgery" @default.
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