Chapter

Yearbook of Intensive Care and Emergency Medicine

Volume 2009 of the series Yearbook of Intensive Care and Emergency Medicine pp 195-204

Determinants of Tissue PCO2 in Shock and Sepsis: Relationship to the Microcirculation

  • A. DubinAffiliated withUnit of Applied Pharmacology, Faculty of Medical Science La Plata National University
  • , V. S. K. EdulAffiliated withUnit of Applied Pharmacology, Faculty of Medical Science La Plata National University
  • , C. InceAffiliated withDepartment of Translational Physiology, Academic Medical Center University of Amsterdam

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Abstract

The development of gastrointestinal tonometry was an important step in the monitoring of tissue dysoxia. It rapidly became a useful tool in basic research. In addition, and for the first time, a regional parameter could be used to detect and to treat hypoperfusion. From an experimental point of view, tonometry adequately tracks intramucosal acidosis [1], i.e., the increase in intramucosal-arterial PCO2 difference (ΔPCO2). Likewise, the increase in ΔPCO2 is better than other systemic and intestinal variables to show tissue hypoperfusion in normal volunteers [2] and in experimental models [3]. Intramucosal acidosis is a sensitive predictor of gastric [4] and colonic mucosal ischemia [5]. Furthermore, gastric tonometry is an insightful predictor of outcome. This usefulness has been shown in postoperative [6], critically ill [7], septic [8] and shock [9] patients. Gastric tonometry might also be used to assess the effect of vasoactive drugs [10, 11]. Finally, intramucosal pH (pHi) has been evaluated as a guide for resuscitation. Gutierrez et al. [12] demonstrated in a randomized controlled trial that pHi-guided therapy could decrease mortality in critically ill patients.