| Continuous assessment of gastric intramucosal PCO2 and pH in hemorrhagic shock using capnometric recirculating gas tonometry. | |
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MedLine Citation:
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PMID: 9118673 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To test a novel device for continuous monitoring of gut intramucosal PCO2 and pH and to compare its use with conventional intermittent saline balloon-tonometry in a model of hemorrhagic shock. DESIGN: A prospective animal study. SETTINGS: A university research laboratory. SUBJECTS: Eight anesthetized, mechanically ventilated mongrel dogs. INTERVENTIONS: Two balloon-tip tonometry catheters, one conventional and one modified for continuous recirculating gas tonometry, were inserted into each animal's stomach by the oral route. Gastric intramucosal PCO2 was recorded continuously by capnometric recirculating gas tonometry throughout the experiment. After a baseline period of 90 mins, vital signs, arterial and mixed venous blood gases, and intramucosal PCO2 values were obtained by recirculating gas tonometry and by the conventional method. Using a modified Wiggers' model, the animals were then subjected to hemorrhage of up to 45 mL/kg, or the volume required to effect a decrease in mean arterial pressure to < 30 mm Hg. After 30 mins, the shed blood was reinfused and the experiment continued for an additional 30 mins. Vital signs, arterial and mixed venous blood samples, saline tonometry samples, and recirculating gas tonometry readings were obtained immediately before and 30 mins after reinfusion of blood. MEASUREMENTS AND MAIN RESULTS: Mean +/- SD baseline intramucosal PCO2 was 47.6 +/- 9.5 torr (6.3 +/- 1.3 kPa) by capnometric recirculating gas tonometry and 45.8 +/- 3.4 torr (6.1 +/- 0.5 kPa) by conventional saline tonometry (p = NS). By 5 mins after inducing hemorrhage, intramucosal PCO2 by recirculating gas tonometry had increased significantly (49.3 +/- 9.7 torr [6.6 +/- 1.3 kPa]; p < .05), and by 30 mins, it had increased to 59.7 +/- 11.3 torr (8.0 +/- 1.5 kPa; p < .001 compared with baseline). After 30 mins of hemorrhage, the conventional method showed an increase in intramucosal PCO2 to 63.0 +/- 20.9 torr (8.4 kPa +/- 2.8 kPa; p = NS vs. baseline by conventional method; p = NS vs. corresponding recirculating gas tonometry values). Gastric intramucosal pH, as determined by recirculating gas tonometry, decreased significantly at 5 mins after starting hemorrhage (7.13 +/- 0.10 to 7.10 +/- 0.10, p < .02). After 30 mins of hemorrhage, intramucosal pH decreased to 6.88 +/- 0.14 (from 7.10 +/- 0.10) by the conventional saline tonometry technique (p < .01) and to 6.89 +/- 0.10 by recirculating gas tonometry (p < .001 vs. baseline). Intramucosal PCO2 by both techniques remained significantly increased above baseline values 30 mins after reinfusion of the shed blood. CONCLUSIONS: Capnometric recirculating gas tonometry allows continuous and automated assessment of gastrointestinal tract perfusion by providing on-line measurements of intramucosal PCO2, which can also be used to derive intramucosal pH. The technique is able to detect changes in intramucosal PCO2 in response to an induced insult over intervals as short as 5 mins. |
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Authors:
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J A Guzman; J A Kruse |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Critical care medicine Volume: 25 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 1997 Mar |
Date Detail:
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Created Date: 1997-04-24 Completed Date: 1997-04-24 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 533-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Balloon Dilatation Blood Gas Analysis Capnography / instrumentation, methods* Carbon Dioxide / analysis* Disease Models, Animal Dogs Gastric Mucosa / chemistry* Hydrogen-Ion Concentration Monitoring, Physiologic Oxygen Consumption Reproducibility of Results Shock, Hemorrhagic / metabolism* |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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