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

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Book cover Intensive Care Medicine

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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.

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Authors and Affiliations

  1. Unit of Applied Pharmacology Faculty of Medical Science, La Plata National University, 1900, La Plata, Buenos Aires, Argentina

    A. Dubin & V. S. K. Edul

  2. Department of Translational Physiology Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands

    C. Ince

Authors
  1. A. Dubin
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  2. V. S. K. Edul
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  3. C. Ince
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Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Universitée libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

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Dubin, A., Edul, V.S.K., Ince, C. (2009). Determinants of Tissue PCO2 in Shock and Sepsis: Relationship to the Microcirculation. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92278-2_19

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  • DOI: https://doi.org/10.1007/978-0-387-92278-2_19

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92277-5

  • Online ISBN: 978-0-387-92278-2

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