Urinary PCO2 for hemodynamically unstable patients

Gastric intramural pH (pHi) derived from gastric PCO2 has been successfully used to assess splanchnic ischemia for patients with unstable hemodynamics, but with some limitations. Urinary bladder, also an easily accessible hollow viscus, should provide as a useful route for the same purpose. However,...

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Published inZhonghua yi xue za zhi (Taipei, Taiwan) Vol. 57; no. 2; p. 112
Main Authors Lin, M S, Lien, T C, Yang, W C, Wu, S C, Tsai, W W, Wang, J H
Format Journal Article
LanguageEnglish
Published China (Republic : 1949- ) 01.02.1996
Subjects
Aged
Carbon Dioxide - urine
Cardiovascular Diseases - diagnosis
Cardiovascular Diseases - physiopathology
Critical Illness
Female
Hemodynamics
Humans
Male
Middle Aged
Partial Pressure
Predictive Value of Tests
Prospective Studies
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Summary:Gastric intramural pH (pHi) derived from gastric PCO2 has been successfully used to assess splanchnic ischemia for patients with unstable hemodynamics, but with some limitations. Urinary bladder, also an easily accessible hollow viscus, should provide as a useful route for the same purpose. However, no study has used urinary PCO2 to evaluate the adequacy of perfusion in critically ill patients. Fifty patients admitted to intensive care unit were included and divided into hemodynamically stable and unstable groups. Several parameters such as arterial pressure, dopamine dosage, heart rate, serum lactate, arterial blood gas, urinary PCO2, and concentrations of Na, K and Cl in urine were measured. Patients with some other renal or pre-renal conditions that might affect urinary PCO2 were excluded. Urinary PCO2 was markedly higher (78.6 +/- 9.9 vs. 43.1 +/- 1.7 mmHg, p < 0.0001) in unstable group. Serum anion gap level, dopamine dosage and heart rate were significantly higher and PaO2/FiO2 ratio as well as mean arterial pressure was lower in unstable group. Serum lactate, arterial pH and other parameters failed to distinguish between groups. Dopamine dosage significantly correlated with urinary PCO2 (r = 0.5357, p = 0.0149) in unstable group. With careful selection of patients, urinary PCO2 can effectively differentiate hemodynamically unstable patients from stable ones. It also correlates significantly with dopamine dosage in patients with unstable hemodynamics.
ISSN:0578-1337