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Critical Care
Published in: Critical Care 2/2005

01-04-2005 | Commentary

Blood flow, not hypoxia, determines intramucosal PCO2

Author: Guillermo Gutierrez

Published in: Critical Care | Issue 2/2005

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Abstract

Monitoring tissue hypoxia in critically ill patients is a challenging task. Tissue PCO2 has long been proposed as a marker of tissue hypoxia, although there is considerable controversy on whether the rise in CO2 with hypoxia is caused by anaerobic metabolism and excess CO2 production or by the accumulation of aerobically produced CO2 in the setting of blood flow stagnation. The prevention of increases in intestinal PCO2 in aggressively resuscitated septic animals supports the notion that tissue CO2 accumulation is a function of decreases in blood flow, not of tissue hypoxia.
Literature
1.
Bersten AD, Holt AW: Vasoactive drugs and the importance of renal perfusion pressure. New Horiz 1995, 3: 650-661.PubMed
2.
Asfar P, De Backer D, Meier-Hellmann A, Radermacher P, Sakka SG: Clinical review: influence of vasoactive and other therapies on intestinal and hepatic circulations in patients with septic shock. Crit Care 2004, 8: 170-179. 10.1186/cc2418PubMedCentralCrossRefPubMed
3.
Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, Heard SO, Martin C, Napolitano LM, Susla GM, et al.: Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004, 32: 1928-1948. 10.1097/01.CCM.0000139761.05492.D6CrossRefPubMed
4.
Vincent JL, De Backer D: Oxygen transport – the oxygen delivery controversy. Intensive Care Med 2004, 30: 1990-1996. 10.1007/s00134-004-2384-4CrossRefPubMed
5.
Kern JW, Shoemaker WC: Meta-analysis of hemodynamic optimization in high-risk patients. Crit Care Med 2002, 30: 1686-1692. 10.1097/00003246-200208000-00002CrossRefPubMed
6.
Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R: A trial of goal-oriented hemodynamic therapy in critically ill patients. S v O 2 Collaborative Group. N Engl J Med 1995, 333: 1025-1032. 10.1056/NEJM199510193331601CrossRefPubMed
7.
Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330: 1717-1722. 10.1056/NEJM199406163302404CrossRefPubMed
8.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed
9.
Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Valdivia A, Sailors RM, Moore FA: Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 2003, 138: 637-642. 10.1001/archsurg.138.6.637CrossRefPubMed
10.
Gutierrez G, Taylor D: Gastrointestinal tonometry: basic principles and recent advances in monitoring regional CO 2 metabolism. Semin Respir Crit Care Med 1999, 20: 17-27.CrossRef
11.
Toledo Maciel A, Creteur J, Vincent JL: Tissue capnometry: does the answer lie under the tongue? Intensive Care Med 2004, 30: 2157-2165. 10.1007/s00134-004-2416-0CrossRef
12.
Totapally BR, Fakioglu H, Torbati D, Wolfsdorf J: Esophageal capnometry during hemorrhagic shock and after resuscitation in rats. Crit Care 2003, 7: 79-84. 10.1186/cc1856PubMedCentralCrossRefPubMed
13.
14.
Dubin A, Murias G, Estenssoro E, Canales H, Badie J, Pozo M, Sottile JP, Baran M, Palizas F, Laporte M: Intramucosal–arterial PCO 2 gap fails to reflect intestinal dysoxia in hypoxic hypoxia. Crit Care 2002, 6: 514-520. 10.1186/cc1813PubMedCentralCrossRefPubMed
15.
Vallet B, Teboul JL, Cain S, Curtis S: Venoarterial CO 2 difference during regional ischemic or hypoxic hypoxia. J Appl Physiol 2000, 89: 1317-1321.PubMed
16.
Dubin A, Murias G, Maskin B, Pozo MO, Sottile JP, Barán M, Edul VSK, Canales HS, Badie JC, Etcheverry G, Estenssoro E: Increased blood flow prevents intramucosal acidosis in sheep endotoxemia: a controlled study. Critical Care 2005, 9: R66-R73. 10.1186/cc3021PubMedCentralCrossRefPubMed
17.
Gutierrez G: Tissue CO 2 concentration is not a marker of dysoxia: a mathematical model of CO 2 exchange. Am J Respir Crit Care Med 2004, 169: 525-533. 10.1164/rccm.200305-702OCCrossRefPubMed
18.
Silverman HJ, Tuma P: Gastric tonometry in patients with sepsis. Effects of dobutamine infusions and packed red blood cell transfusions. Chest 1992, 102: 184-188.CrossRefPubMed
Metadata
Title
Blood flow, not hypoxia, determines intramucosal PCO2
Author
Guillermo Gutierrez
Publication date
01-04-2005
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3489

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