PMID: 9555845Apr 29, 1998Paper

Relationship between systemic oxygen supply dependency and gastric intramucosal PCO2 during progressive hemorrhage

The Journal of Trauma
J A GuzmanJ A Kruse

Abstract

As systemic oxygen delivery (DO2) is reduced, oxygen consumption (VO2) is maintained until a critical level is reached (DO2crit) below which VO2 becomes supply-dependent and anaerobic metabolism ensues. We examined the relationship between gastric intramucosal PCO2 (PiCO2) and the onset of systemic supply dependency. We also compared PiCO2 to mixed venous and portal venous blood PCO2 (PmvCO2 and PpvCO2) to assess their utility as premonitory indicators of supply dependency. Six dogs were subjected to stepwise hemorrhage to effect a progressive decrease in DO2. Inflection points for changes in VO2, PiCO2, PmvCO2, and PpvCO2 versus DO2 were determined. Mean DO2crit was 6.0 +/- 0.7 mL x kg(-1) x min(-1), whereas the DO2 at which inflection points occurred for PiCO2 and PpvCO2 were 13.2 +/- 1.4 and 11.2 +/- 1.5 mL x kg(-1) x min(-1), respectively (p < 0.05 for both). Continuous monitoring of PiCO2 using capnometric recirculating gas tonometry can serve as an early indicator of systemic hypoperfusion before the onset of systemic supply dependency.

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Citations

Apr 13, 1999·Critical Care Medicine·J A Kruse
Nov 30, 2000·Critical Care : the Official Journal of the Critical Care Forum·G AcklandM G Mythen
Apr 2, 2009·Critical Care : the Official Journal of the Critical Care Forum·Fernando PalizasGlenn Hernández
Feb 15, 2011·Critical Care Nursing Clinics of North America·David J Lundy, Stephen Trzeciak
Apr 27, 2010·Resuscitation·Kevin R WardVictor A Convertino
Nov 7, 2009·Critical Care Clinics·David J Lundy, Stephen Trzeciak
Apr 29, 2008·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Stephen TrzeciakUNKNOWN Microcirculatory Alterations in Resuscitation and Shock (MARS) Investigators
Nov 11, 2006·Annals of Emergency Medicine·Stephen TrzeciakUNKNOWN Microcirculatory Alterations in Resuscitation and Shock Investigators
Mar 6, 2003·Critical Care : the Official Journal of the Critical Care Forum·Balagangadhar R TotapallyJack Wolfsdorf
Aug 27, 2004·Anesthesiology·Andrea MorelliPaolo Pietropaoli
Sep 13, 2001·European Journal of Anaesthesiology·G LebuffeB Vallet
Apr 2, 2015·Current Opinion in Critical Care·Alexandre Lima, Jan Bakker
Mar 8, 2006·Critical Care Medicine·Kevin R WardJames Terner
Nov 28, 2002·Current Opinion in Critical Care·Ravindra L MehtaMiet Schetz
Jan 24, 2020·Critical Care Medicine·Wasineenart MongkolpunJacques Creteur
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Mar 25, 2020·Critical Care Medicine·Wasineenart MongkolpunJacques Creteur

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