Sublingual capnometry: a non-invasive measure of microcirculatory dysfunction and tissue hypoxia

Abstract

With improvement in supportive care patients rarely die from their presenting illness but rather from its sequela, namely sequential multi-organ failure. Tissue hypoxia is believed to be the causation of multi-organ dysfunction syndrome (MODS). The expedient detection and correction of tissue hypoxia may therefore limit the development of MODS. The standard oxygenation and hemodynamic variables (blood pressure, arterial oxygenation, cardiac output) which are monitored in critically ill patients are 'upstream' markers and provide little information as to the adequacy of tissue oxygenation. Global 'downstream' markers such as mixed venous oxygen saturation and blood lactate are insensitive indicators of tissue hypoxia. Sublingual PCO(2) is a regional marker of microvascular perfusion and tissue hypoxia that holds great promise for the risk stratification and end-point of goal directed resuscitation in critically ill patients. This paper reviews the technology and application of sublingual PCO(2) monitoring.

The microcirculation of the critically ill pediatric patient

“…However, the relationship between lactate and tissue perfusion is not always well defined [23-25], possibly due to the fact that measured lactate is not only the result of the balance between anaerobic production and clearance, but that it may also arise from other sources than hypoxic tissues [26]. Overall these macrocirculatory parameters are currently considered as insensitive markers of tissue perfusion [27].…”

Noninvasive monitoring of peripheral microcirculatory hemodynamics under varying degrees of hypoxia

“…The microcirculation of the skin and its regulation have been investigated under normal and pathological conditions, including various respiratory states (Babchenko et al, 1999;Levy et al, 2015), diabetes (Arora et al, 2002;Golster et al, 2005;Hosking et al, 2013;Kasalova et al, 2006;Marik, 2006;Shah et al, 2014;Urbancic-Rovan et al, 2006), vascular diseases (De Graaff et al, 2003;Morales et al, 2005;Otah et al, 2005;Przywara et al, 2004;Salminen et al, 2014), and smoking (Arora et al, 2002;Dalla et al, 2004;Rossi et al, 2014). Our aim here was to test the ability of http://dx.doi.org/10.1016/j.resp.2015.05.011 1569-9048/© 2015 Elsevier B.V. All rights reserved.…”

Endpoints of Resuscitation

“…Using sublingual mucosal PCO 2 levels, sublingual capnometry has been shown to provide information regarding the adequacy of tissue perfusion in both hemorrhagic and septic shock. [88][89][90][91] In addition, it is able to differentiate between varying degrees of blood loss in trauma patients. 92 Although the easy accessibility of the sublingual mucosa for PCO 2 sampling is attractive, there are limited data supporting the benefits of sublingual capnometry compared with conventional global assessments of hypoperfusion.…”