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Intensive Care Medicine
Published in: Intensive Care Medicine 4/2006

01-04-2006 | Original

Sublingual capnometry tracks microcirculatory changes in septic patients

Authors: Jacques Creteur, Daniel De Backer, Yasser Sakr, Marc Koch, Jean-Louis Vincent

Published in: Intensive Care Medicine | Issue 4/2006

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Abstract

Objective

To test the hypothesis that microcirculatory blood flow is the main determinant of sublingual carbon dioxide pressure in patients with septic shock.

Design

Prospective, open-label study

Setting

A 31-bed medico-surgical department of intensive care.

Patients

Eighteen consecutive mechanically ventilated patients with septic shock.

Interventions

A 5 μg/kg · min dobutamine infusion was used to increase blood flow.

Methods

Sublingual carbon dioxide pressure was monitored using a microelectrode sensor, and sublingual microcirculation was assessed using orthogonal polarization spectral imaging. The sublingual carbon dioxide pressure gap was calculated as the difference between sublingual and arterial carbon dioxide pressures. In each patient, a nasogastric tonometry catheter was inserted for gastric mucosal carbon dioxide pressure measurement. The gastric carbon dioxide pressure gap was calculated as the difference between gastric mucosal and arterial carbon dioxide pressures.

Measurements and results

Dobutamine infusion was associated with increases cardiac index and mixed venous blood oxygen saturation. Dobutamine infusion resulted in decreases in sublingual carbon dioxide pressure gap from 40 ± 15 to 17 ± 8 mmHg (p < 0.01). There was a significant correlation between sublingual and gastric mucosal carbon dioxide pressures (r 2 = 0.61, p < 0.05). At baseline, sublingual carbon dioxide pressure gap correlated with the proportion of well-perfused capillaries (r 2 = 0.80). The decrease in sublingual carbon dioxide pressure gap paralleled the increase in the proportion of well-perfused capillaries in each patient.

Conclusions

Regional microcirculatory blood flow is the main determinant of sublingual carbon dioxide pressure. Sublingual capnometry could represent a simple, non-invasive method to monitor these microcirculatory alterations in septic patients.
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Metadata
Title
Sublingual capnometry tracks microcirculatory changes in septic patients
Authors
Jacques Creteur
Daniel De Backer
Yasser Sakr
Marc Koch
Jean-Louis Vincent
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 4/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0070-4

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