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Regional Capnography

  • Jihad Mallat
  • Benoit Vallet
Chapter

Abstract

In critically ill patients, tissue hypoperfusion is an important cause leading to multi-organ dysfunction and death, and it cannot always be detected by measuring standard global hemodynamic and oxygen-derived parameters. Gastric intramucosal PCO2 as measured by gastric tonometry has been recognized to be of clinical value as a prognostic factor, in assessing the effects of particular therapeutic interventions, and as an endpoint of resuscitation. However, this technique has several limitations that have hampered its implementation in clinical practice. The sublingual tissue bed has been shown to be damaged in models of shock, and microcirculatory changes in this area may indicate imminent changes in other important organs. The measurement of sublingual mucosal PCO2 (PslCO2) by sublingual capnography is technically simple and noninvasive and gives near instantaneous results. Clinical studies have established that high PslCO2 values and, more especially, high PslCO2 gap (PslCO2—arterial PCO2) values are correlated with impaired microcirculatory blood flow and a poor outcome in critically ill patients. Sublingual capnography seems to be the ideal noninvasive monitoring tool to evaluate the severity of shock states and the adequacy of tissue perfusion.

Keywords

Tissue hypoperfusion Tissue PCO2 Tissue PCO2 gap Gastric tonometry Sublingual capnography Critical care Shock Microcirculatory alterations 

Notes

Competing Interests

None of the authors have any potential financial or nonfinancial conflict of interest related to this manuscript.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jihad Mallat
    • 1
  • Benoit Vallet
    • 2
  1. 1.Department of Anesthesiology and Critical Care Medicine, Service de Réanimation polyvalenteCentre Hospitalier du Dr. Schaffner de LensLensFrance
  2. 2.Department of Anesthesiology and Critical Care MedicineCentre Hospitalier Universitaire de LilleLilleFrance

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