Intramucosal-Arterial Pco2 Gradient Does Not Reflect Intestinal Dysoxia in Anemic Hypoxia

Dubin, Arnaldo; Bakker, Jan; Murias, Tiberio Feliz; Pozo, Mario Omar; Sottile, Juan P.; Barán, Marcelo; Piacentini, Enrique; Canales, Héctor Saúl; Etcheverry, Graciela

doi:10.1097/01.ta.0000107182.43213.4b

Cited by 60 publications

(84 citation statements)

References 38 publications

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“…Under stable haemodynamic circumstances, PgCO 2 reflects the balance between carbon dioxide production and carbon dioxide elimination by the gastric mucosal blood flow. PgCO 2 increase is predominantly due to reduced washout of carbon dioxide, and can be taken as an alarm of a situation at risk of circulatory failure and a low flow state [42]. Tonometry has also been used to monitor the colonic mucosa during aortic surgery [13] and during CPB [22].…”

Section: Discussionmentioning

confidence: 99%

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

et al. 2007

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SummaryThe aim of this prospective study was to determine the feasibility of intestinal endoluminal microdialysis as a new method for clinical monitoring of the adequacy of splanchnic perfusion in the large bowel. A microdialysis catheter for continuous lactate, glycerol, glucose and pyruvate measurements attached to a tonometric catheter was placed into the lumen of the recto-sigmoid junction prior to surgery in 13 patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Lactate was also measured in blood and muscle. CPB was associated with a 10-fold increase in luminal lactate from 0.16 (0.01) to 1.67 (0.38) mmol.l )1 (p < 0.001). Muscular lactate increased from baseline levels 1.20 (0.21) to 1.77 (0.36) mmol.l )1 during CPB (p = 0.01), but the muscular lactate-pyruvate ratio remained unchanged. Arterial lactate increased only slightly from 0.9 (0.05) to 1.1 (0.06) mmol.l )1 (p = 0.027) during CPB. Increased lactate concentrations in the large bowel during CPB are suggestive of local lactate production consistent with impaired oxygen delivery. Intestinal endoluminal microdialysis is a potential clinically applicable method for monitoring intestinal metabolism. Combined with tonometry, microdialysis provides the opportunity to monitor both circulation and metabolism in the rectal mucosa. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk of developing intestinal mucosal ischaemia, leading to disturbed mucosal integrity and increased intestinal permeability [1]. The latter may result in leakage of endotoxins into the circulation contributing to systemic inflammation observed during CPB [2]. The most likely cause of increased intestinal vascular permeability is imbalance between splanchnic oxygen supply and demand [3].There are currently few reliable methods available for monitoring adequacy of splanchnic perfusion during CPB. If available, these data could lead to strategies being developed to reduce intestinal ischaemia and the resulting increased mucosal permeability. Gastric tonometry is the only clinically available method that allows monitoring of gastro-intestinal perfusion. Even though in cardiac [4,5] and high-risk surgical patients [6] peri-operative tonometry-derived variables are predictive

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Section: Discussionmentioning

confidence: 99%

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

et al. 2007

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“…The elegant idea of gauging dysoxia via PCO 2 gradients (ΔPCO 2 ) provides the basis for gastro-intestinal tonometry, one of the few clinical tools presently available for the monitoring of tissue oxygenation 6 . At first regarded as a promising candidate for the early detection of dysoxia and regional hypoperfusion, critical concerns about methodological inaccuracies 7 suggest a reduced, albeit still valuable role of ΔPCO 2 for the monitoring of the microcirculation only. However, as it cannot reliably detect anaerobic metabolism when flow is preserved, gastro-intestinal tonometry fails to reflect the oxygen supply dependency during hypoxic episodes witnessed under conditions of oxidative stress in the critical vascular bed of the gut.…”

Section: The Carbon Footprint Of Cellular Respirationmentioning

confidence: 99%

Significance of venous oximetry in the critically ill

2008

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Critically ill patients are threatened or affected by multi-organ failure (MOF). IMPORTANCIA DE LA OXIMETRÍA VENOSA EN EL ENFERMO CRÍTICO Los enfermos críticos tienen riesgo de fracaso multiorgánico (FMO) o ya lo sufren. La hipoxia tisular es uno de los cofactores más importantes de FMO. La oximetría venosa permite la estimación crítica de la ratio de aporte-demanda del oxí-geno global (O 2 ) y puede ser obtenida de la sangre venosa mixta (S v O 2 ) y central (S cv O 2 ). Las necesidades celulares dominan la jerarquía de retroalimentación del metabolismo de O 2 . Esta revisión describe la historia y validez del control hemodinámico, ilustra el fundamento fisiológico y aplicación clínica de la oximetría venosa y presenta el análisis de dióxido de carbono como prueba de la utilidad del enfoque multimodal en el control cardiorrespiratorio. Se comprueba que la variación del gasto cardiaco, la mejora de la saturación de O 2 arterial y la adaptación de la extracción de O 2 son los niveles importantes para la adaptación fisiopatológica y la intervención terapéutica. Presentamos el perfil de S cv O 2 y S v O 2 y analizamos su importancia diagnóstica, terapéutica y pronós-tica, proporcionando la base para la eficacia de la oximetría venosa como un importante marcador en el enfermo crítico. Finalmente, después de presentar un esquema de los desarrollos actuales para mejorar el conocimiento del balance oxidativo de los órganos individuales, destacamos la importancia de una estrategia sinóptica de monitorización de O 2 , así como la necesidad de utilizar su potencial clínico beneficioso, aún no aprovechado.

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“…Blood flow is the main determinant of tissue CO 2 clearance, and low flow increases the tissue P CO 2 -venous P CO 2 difference. 5,6 Various mechanisms maintain the proportion of CO 2 at low levels in solution in plasma (ϳ5%). Figure 1 shows the ways CO 2 is transported.…”

Section: Physiology Of Carbon Dioxidementioning

confidence: 99%

The Physiology of Ventilation

Murias¹,

Blanch

Lucangelo

2014

Respir Care

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Intramucosal-Arterial Pco2 Gradient Does Not Reflect Intestinal Dysoxia in Anemic Hypoxia

Abstract: DeltaPco2 did not reflect intestinal dysoxia during Vo2/Do2 dependency attributable to hemodilution. Blood flow seems to be the main determinant of DeltaPco2.

Cited by 60 publications

References 38 publications

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

Significance of venous oximetry in the critically ill

The Physiology of Ventilation

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