Gastric pH was measured as a surrogate for mesenteric artery perfusion, which in turn is an indicator of whole body perfusion. (The mesenteric perfusion is among the first compromised when the blood pressure goes down due to compensatory vasoconstriction.) Gastric pH correlated well with significant postoperative morbidity. Also correlating well with poor outcome was your basic blood pH. That does not mean that you could make patients better by giving them bicarbonate. It means that you have to proactively measure the pH and aggressively restore oxygen delivery to the tissues in a timely way. While it was not proven that intervening vs. not intervening would make a difference (that would require a more controlled study), that is the logical and eminently believable extrapolation. Those who defend the use of pulmonary artery catheters make just that point - that putting it in is not important, and maybe dangerous, but managing it to optimize cardiovascular variables intra- and postoperatively truly helps people. This is one study that adds weight to that argument.

An important aspect of this paper is that it presents a simple survey methodology for us to measure how well we do with big cases. This can be used to identify areas of improvement, or to highlight practice superiority as you negotiate better rates for better care from your health care insurance mogul. This paper also can be used to support your efforts to defend payments for hemodynamic monitoring (now under attack by many payers as they insist on confirmatory ICD-9 codes that do not take into account the necessary resuscitative measures highlighted in this paper). By more aggressively optimizing patient hemodynamics in "big" cases, patients should do better, your revenues for hemodynamic monitoring should go up, and total health care costs should come down; and that is a win-win situation if I ever heard one. Thank you Dr. Bennett-Guerrero et al.!