Changes in p i CO 2 reflect splanchnic mucosal ischaemia more reliably than changes in pH i during haemorrhagic shock

Meisner, Franz; Häbler, O.; Kemming, Gregor; Kleen, M.; Pape, Andreas; Meßmer, K.

doi:10.1007/s004230100230

Cited by 11 publications

(6 citation statements)

References 29 publications

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“…P il CO 2 and pH il changed at almost each step of bleeding and P il CO 2 returned to baseline after stabilization. This probably indicates that intestinal PCO 2 better reflects changes in microcirculation in the mucosa than pH i because it is not influenced by any arterial blood gas parameter [40] .…”

Section: Discussionmentioning

confidence: 99%

Measurements of Subcutaneous Tissue PO<sub>2</sub> Reflect Oxygen Metabolism of the Small Intestinal Mucosa during Hemorrhage and Resuscitation

et al. 2009

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Background: The first tissues to be deprived of perfusion and oxygenation in a hypovolemic situation and the last ones to be reperfused are the subcutaneous tissue and the gastrointestinal mucosa. We hypothesized that measurements of subcutaneous tissue gases and pH might reflect simultaneous changes in oxygenation of the intestinal mucosa. The aim of this study was to evaluate tissue gases and pH as measures of tissue oxygenation and tissue oxygen metabolism in subcutaneous and intestinal tissues simultaneously. Material and Methods: Five out of 17 domestic pigs (weight 21–25 kg) were used as controls without bleeding. Twelve animals were bled in 3 steps, 10% of their calculated blood volume at each step. The removed blood, crystalloid and colloid were thereafter infused, and animals were stabilized for 30 min. Measurements were made after each step of bleeding, retransfusion and stabilization. Before bleeding, all animals had a sensor (Paratrend 7™) implanted subcutaneously in the left groin for measurements of tissue gases and pH (P_scO₂, P_scCO₂ and pH_sc). Catheters were positioned in the jugular vein, portal vein, carotid artery, pulmonary artery and femoral artery for infusion, bleeding and oxygen monitoring. Via a midline laparotomy, 2 silicon tonometers (TRIP™ sigmoid catheters) were positioned in the ileum and sigmoid colon for measurements of PCO₂ and pH (P_iICO₂, P_siCO₂, pH_iI and pH_si). Blood flow in the portal vein was measured by an ultrasound probe (H6SB) and a Clark electrode (Cardiff tissue oxymeter) was used for serosal PO₂ measurements of the ileum (P_iIO₂) and sigmoid colon (P_siO₂). Results: After the first step of bleeding, P_scO₂ decreased from 64 ± 17 to 56 ± 22 mm Hg (SD; p < 0.05). P_scCO₂ and pH_sc did not change. P_iICO₂ increased from 64 ± 14 to 79 ± 14 mm Hg (p < 0.05), P_siCO₂ increased from 77 ± 16 to 90 ± 18 mm Hg (p < 0.05). pH_iI decreased from 7.15 ± 0.09 to 7.03 ± 0.09 (p < 0.05). P_iIO₂ and P_siO₂ decreased, but not significantly until steps of further bleeding. After re-transfusion and stabilization, P_scO₂ and P_iICO₂ returned to baseline. Conclusion: Measurements of subcutaneous PO₂ are sensitive to bleeding and resuscitation and reflect oxygen metabolism in the small intestinal mucosa as measured by PCO₂ and pH.

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Section: Discussionmentioning

confidence: 99%

Measurements of Subcutaneous Tissue PO<sub>2</sub> Reflect Oxygen Metabolism of the Small Intestinal Mucosa during Hemorrhage and Resuscitation

et al. 2009

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“…The PCO 2 gap is therefore largely dependent on mucosal perfusion and is considered to be a valid measure for gastrointestinal perfusion 33 . The use of the PCO 2 gap has replaced the use of mucosal pH (pHi, calculated from luminal PCO 2 and blood bicarbonate content) regional ischemia 34,35 . Saline tonometry has been replaced with automated air tonometry because of technical problems, including long equilibration time, variability and lack of quality in the determination of saline PCO 2 , which is discussed elsewhere in more detail [36][37][38] .…”

Section: Tonometrymentioning

confidence: 99%

Gastrointestinal Perfusion in Septic Shock

Haren

Sleigh

Pickkers

et al. 2007

Anaesth Intensive Care

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Septic shock is characterised by vasodilation, myocardial depression and impaired microcirculatory blood flow, resulting in redistribution of regional blood flow. Animal and human studies have shown that gastrointestinal mucosal blood flow is impaired in septic shock. This is consistent with abnormalities found in many other microcirculatory vascular beds. Gastrointestinal mucosal microcirculatory perfusion deficits have been associated with gut injury and a decrease in gut barrier function, possibly causing augmentation of systemic inflammation and distant organ dysfunction.A range of techniques have been developed and used to quantify these gastrointestinal perfusion abnormalities. The following techniques have been used to study gastrointestinal perfusion in humans: tonometry, laser Doppler flowmetry, reflectance spectrophotometry, near-infrared spectroscopy, orthogonal polarisation spectral imaging, indocyanine green clearance, hepatic vein catheterisation and measurements of plasma D-lactate. Although these methods share the ability to predict outcome in septic shock patients, it is important to emphasise that the measurement results are not interchangeable. Different techniques measure different elements of gastrointestinal perfusion. Gastric tonometry is currently the most widely used technique because of its non-invasiveness and ease of use.Despite all the recent advances, the usefulness of gastrointestinal perfusion parameters in clinical decision-making is still limited. Treatment strategies specifically aimed at improving gastrointestinal perfusion have failed to actually correct mucosal perfusion abnormalities and hence not shown to improve important clinical endpoints.Current and future treatment strategies for septic shock should be tested for their effects on gastrointestinal perfusion; to further clarify its exact role in patient management, and to prevent therapies detrimental to gastrointestinal perfusion being implemented.

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“…Whether intestinal CO 2 tonometry represents a precise tool to evaluate regional splanchnic ischaemia is widely debated [21] , but nevertheless, it is applied in numerous clinical and experimental studies. Increased accuracy of measurements may be achieved using a phosphate-buffered solution [22] as well as calculating the PCO 2 gap which better refl ects splanchnic ischaemia [23][24][25] , instead of intramural pH which may vary, depending on systemic arterial PCO 2 . Alternatively, mesenteric ischaemia can be estimated using polarographic electrodes to measure surface oxygen tension.…”

Section: Discussionmentioning

confidence: 99%

Effects of Dopexamine in a Rat Model of Supracoeliac Aortic Cross-Clamping and Declamping

Studer¹,

Wu²,

Siegemund³

et al. 2006

Eur Surg Res

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This experimental study in rats was designed to demonstrate effects of dopexamine (3 µg kg^–1 min^–1, n = 6) or physiologic saline solution (n = 6) on systemic as well as regional perfusion during 30 min of supracoeliac aortic cross-clamping and during 180 min of reperfusion following declamping. Rats were surgically instrumented with arterial, right atrial and portal venous catheters, ultrasonic flow probes around the abdominal aorta, superior mesenteric and carotid artery, and a paediatric tonometer for intestinal mucosal PCO₂ measurement. During 120 min of reperfusion, fluid resuscitation was titrated to keep abdominal aortic blood flow above 80% of baseline values. We found that during cross-clamping, values of arterial lactate (p = 0.002) and intestinal tonometric PCO₂ (p = 0.018) were higher in the dopexamine group than in the control group.

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Changes in p i CO 2 reflect splanchnic mucosal ischaemia more reliably than changes in pH i during haemorrhagic shock

Cited by 11 publications

References 29 publications

Measurements of Subcutaneous Tissue PO<sub>2</sub> Reflect Oxygen Metabolism of the Small Intestinal Mucosa during Hemorrhage and Resuscitation

Measurements of Subcutaneous Tissue PO<sub>2</sub> Reflect Oxygen Metabolism of the Small Intestinal Mucosa during Hemorrhage and Resuscitation

Gastrointestinal Perfusion in Septic Shock

Effects of Dopexamine in a Rat Model of Supracoeliac Aortic Cross-Clamping and Declamping

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