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Esophageal capnometry during hemorrhagic shock and after resuscitation in rats.

Totapally BR, Fakioglu H, Torbati D, Wolfsdorf J - Crit Care (2002)

Bottom Line: Base deficit increased significantly following severe hemorrhage and remained significantly elevated after blood reinfusion.Significant correlations were found between base deficit and PeCO2-PaCO2 (P < 0.002) and PeCO2 (P < 0.022).Blood bicarbonate concentration decreased significantly following mild and severe hemorrhage, but its recovery was not complete at 60 min after blood reinfusion.

View Article: PubMed Central - PubMed

Affiliation: Associate Professor and Research Director, Division of Critical Care Medicine, Miami Children's Hospital, Miami, Florida, USA. Dan.Torbati@MCH.Com

ABSTRACT

Background: Splanchnic perfusion following hypovolemic shock is an important marker of adequate resuscitation. We tested whether the gap between esophageal partial carbon dioxide tension (PeCO2) and arterial partial carbon dioxide tension (PaCO2) is increased during graded hemorrhagic hypotension and reversed after blood reinfusion, using a fiberoptic carbon dioxide sensor.

Materials and method: Ten Sprague-Dawley rats were anesthetized, tracheotomized, and cannulated in one femoral artery and vein. A calibrated fiberoptic PCO2 probe was inserted into the distal third of the esophagus for determination of luminal PeCO2 during maintained anesthesia (pentobarbital 15 mg/kg per hour), normothermia (38 +/- 0.5 degrees C), and fluid balance (saline 5 ml/kg per hour). Three out of 10 rats were used to determine the limits of hemodynamic stability during gradual hemorrhage. Seven of the 10 rats were then subjected to mild and severe hemorrhage (15 and 20-25 ml/kg, respectively). Thirty minutes after severe hemorrhage, these rats were resuscitated by reinfusion of the shed blood. Arterial gas exchange, hemodynamic variables, and PeCO2 were recorded at each steady-state level of hemorrhage (at 30 and 60 min) and after resuscitation.

Results: The PeCO2-PaCO2 gap was significantly increased after mild and severe hemorrhage and returned to baseline (prehemorrhagic) values following blood reinfusion. Base deficit increased significantly following severe hemorrhage and remained significantly elevated after blood reinfusion. Significant correlations were found between base deficit and PeCO2-PaCO2 (P < 0.002) and PeCO2 (P < 0.022). Blood bicarbonate concentration decreased significantly following mild and severe hemorrhage, but its recovery was not complete at 60 min after blood reinfusion.

Conclusion: Esophageal-arterial PCO2 gap increases during graded hemorrhagic hypotension and returns to baseline value after resuscitation without complete reversal of the base deficit. These data suggest that esophageal capnometry could be used as an alternative for gastric tonometry during management of hypovolemic shock.

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Linear regression analysis of the association between partial esophageal carbon dioxide tension (PeCO2) and base deficit in seven anesthetized, spontaneously breathing rats during mild and severe hemorrhagic hypotension. Dotted lines represent the upper and lower limits of 95% confidence interval.
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Figure 3: Linear regression analysis of the association between partial esophageal carbon dioxide tension (PeCO2) and base deficit in seven anesthetized, spontaneously breathing rats during mild and severe hemorrhagic hypotension. Dotted lines represent the upper and lower limits of 95% confidence interval.

Mentions: The PeCO2–PaPCO2 was significantly increased after mild and severe hemorrhage, and returned to baseline values following blood reinfusion (Fig. 1). The base deficit became slightly more negative after mild hemorrhage but was significantly reduced after severe hemorrhage (-5.5 mmol/l and -14.4 mmol/l, respectively). The base deficit remained significantly high after blood reinfusion (-7.2 mmol/l after 60 min). After blood reinfusion, unlike base deficit, the PaCO2 rapidly normalized (Table 1). A significant correlation was found between base deficit and PeCO2–PaCO2 gap during hemorrhagic hypotension (Fig. 2; r2 = 0.39, P < 0.002). At the same time, there was also a significant correlation between base deficit and PeCO2 (Fig. 3; r2 = 0.24, P < 0.022).


Esophageal capnometry during hemorrhagic shock and after resuscitation in rats.

Totapally BR, Fakioglu H, Torbati D, Wolfsdorf J - Crit Care (2002)

Linear regression analysis of the association between partial esophageal carbon dioxide tension (PeCO2) and base deficit in seven anesthetized, spontaneously breathing rats during mild and severe hemorrhagic hypotension. Dotted lines represent the upper and lower limits of 95% confidence interval.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC154116&req=5

Figure 3: Linear regression analysis of the association between partial esophageal carbon dioxide tension (PeCO2) and base deficit in seven anesthetized, spontaneously breathing rats during mild and severe hemorrhagic hypotension. Dotted lines represent the upper and lower limits of 95% confidence interval.
Mentions: The PeCO2–PaPCO2 was significantly increased after mild and severe hemorrhage, and returned to baseline values following blood reinfusion (Fig. 1). The base deficit became slightly more negative after mild hemorrhage but was significantly reduced after severe hemorrhage (-5.5 mmol/l and -14.4 mmol/l, respectively). The base deficit remained significantly high after blood reinfusion (-7.2 mmol/l after 60 min). After blood reinfusion, unlike base deficit, the PaCO2 rapidly normalized (Table 1). A significant correlation was found between base deficit and PeCO2–PaCO2 gap during hemorrhagic hypotension (Fig. 2; r2 = 0.39, P < 0.002). At the same time, there was also a significant correlation between base deficit and PeCO2 (Fig. 3; r2 = 0.24, P < 0.022).

Bottom Line: Base deficit increased significantly following severe hemorrhage and remained significantly elevated after blood reinfusion.Significant correlations were found between base deficit and PeCO2-PaCO2 (P < 0.002) and PeCO2 (P < 0.022).Blood bicarbonate concentration decreased significantly following mild and severe hemorrhage, but its recovery was not complete at 60 min after blood reinfusion.

View Article: PubMed Central - PubMed

Affiliation: Associate Professor and Research Director, Division of Critical Care Medicine, Miami Children's Hospital, Miami, Florida, USA. Dan.Torbati@MCH.Com

ABSTRACT

Background: Splanchnic perfusion following hypovolemic shock is an important marker of adequate resuscitation. We tested whether the gap between esophageal partial carbon dioxide tension (PeCO2) and arterial partial carbon dioxide tension (PaCO2) is increased during graded hemorrhagic hypotension and reversed after blood reinfusion, using a fiberoptic carbon dioxide sensor.

Materials and method: Ten Sprague-Dawley rats were anesthetized, tracheotomized, and cannulated in one femoral artery and vein. A calibrated fiberoptic PCO2 probe was inserted into the distal third of the esophagus for determination of luminal PeCO2 during maintained anesthesia (pentobarbital 15 mg/kg per hour), normothermia (38 +/- 0.5 degrees C), and fluid balance (saline 5 ml/kg per hour). Three out of 10 rats were used to determine the limits of hemodynamic stability during gradual hemorrhage. Seven of the 10 rats were then subjected to mild and severe hemorrhage (15 and 20-25 ml/kg, respectively). Thirty minutes after severe hemorrhage, these rats were resuscitated by reinfusion of the shed blood. Arterial gas exchange, hemodynamic variables, and PeCO2 were recorded at each steady-state level of hemorrhage (at 30 and 60 min) and after resuscitation.

Results: The PeCO2-PaCO2 gap was significantly increased after mild and severe hemorrhage and returned to baseline (prehemorrhagic) values following blood reinfusion. Base deficit increased significantly following severe hemorrhage and remained significantly elevated after blood reinfusion. Significant correlations were found between base deficit and PeCO2-PaCO2 (P < 0.002) and PeCO2 (P < 0.022). Blood bicarbonate concentration decreased significantly following mild and severe hemorrhage, but its recovery was not complete at 60 min after blood reinfusion.

Conclusion: Esophageal-arterial PCO2 gap increases during graded hemorrhagic hypotension and returns to baseline value after resuscitation without complete reversal of the base deficit. These data suggest that esophageal capnometry could be used as an alternative for gastric tonometry during management of hypovolemic shock.

Show MeSH
Related in: MedlinePlus