Comparisons Between Sublingual and Gastric Tonometry During Hemorrhagic Shock

• Published in: Chest Vol. 118; no. 4; pp. 1127 - 1132
• Main Authors: Povoas, Heitor P., Weil, Max Harry, Tang, Wanchun, Moran, Buzz, Kamohara, Takashi, Bisera, Joe
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.10.2000; American College of Chest Physicians
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Automation; Biological and medical sciences; Blood Pressure; Capnography - methods; Carbon dioxide; carbon dioxide tension; Cardiac Output; Catheters; Coronary vessels; Critical care; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; gastric tonometry; Hemorrhagic shock; Intensive care medicine; Laboratory animals; Male; Medical sciences; Prospective Studies; Pulmonary arteries; Sensors; Severity of Illness Index; Shock (Circulatory); Shock, Hemorrhagic - physiopathology; Stomach; sublingual capnometry; Swine; Tongue; Veins & arteries; ETco2; Psl2co2; Psl1co2; hemorrhagic shock; Pg1co2; Pg2co2; pHi; gastric tonometry; Pslco2; Pgco2; sublingual capnometry; carbon dioxide tension; MAP; Shock; Blood gas; Intensive cardiocirculatory care; Stomach; PaCO2; Sublingual administration; Cardiovascular disease; Exploration; Hemorrhage; Pig; Vertebrata; Mammalia; Animal; Tonometry; Artiodactyla; Technique; Ungulata; Comparative study
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.118.4.1127

To compare sublingual tissuePco2, a disarmingly simple and noninvasivemeasurement of the severity of perfusion failure, with gastrictonometric Pco2 during hemorrhagic shock infive male domestic pigs weighing between 35 and 40 kg. Prospective animal study. Animal laboratory in a research institution. Domestic pigs. Hemorrhagic shock was induced by amodification of the Wigger's method. BP was maintained at 50 mm Hg for120 min followed by reinfusion of shed blood at a rate of 100 mL/minwith the aid of an infusion pump. During bleeding, the mean arterial pressure decreasedfrom an average of 127 to 42 mm Hg, and cardiac output decreased from7.7 to 2.4 L/min. Arterial blood lactate concentration concurrentlyincreased from 1.2 to 13.9 mmol/L. SublingualPco2 (Pslco2)increased from 59 to 105 mm Hg, and gastricPco2 increased from 61 to 111 mm Hg. Thecorrelation between time-coincident sublingual and gastric measurementsof Pco2 was r = 0.91(p < 0.0001). Bland-Altman analyses demonstrated a closecorrespondence between the two measurements. The reinfusion of shedblood promptly reversed the hemodynamic abnormalities and reestablishedgastric and Pslco2 to near baseline values. This contrasted with a delayed reversal of lactic acidosis. Under experimental conditions of hemorrhagicshock, sublingual capnometry yielded measurements that wereinterchangeable with those of gastric tonometry.