Abstract
BackgroundDespite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO2 and artPCO2 (tc-artPCO2) with the systemic oxygen metabolism and hemodynamic parameters. Our study aimed to test the hypothesis that tc-artPCO2 can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation.MethodsThis prospective animal study was performed using female pigs at a university-based experimental laboratory. Progressive massive hemorrhagic shock was induced in mechanically ventilated pigs by stepwise blood withdrawal. All animals were then resuscitated by transfusing the stored blood in stages. A transcutaneous monitor was attached to their ears to measure tcPCO2. A pulmonary artery catheter (PAC) and pulse index continuous cardiac output (PiCCO) were used to monitor cardiac output (CO) and several hemodynamic parameters. The relationships of tc-artPCO2 with the study parameters and systemic oxygen delivery (DO2) were analyzed.ResultsHemorrhage and blood transfusion precisely impacted hemodynamic and laboratory data as expected. The tc-artPCO2 level markedly increased as CO decreased. There were significant correlations of tc-artPCO2 with DO2 and COs (DO2: r = − 0.83, CO by PAC: r = − 0.79; CO by PiCCO: r = − 0.74; all P < 0.0001). The critical level of oxygen delivery (DO2crit) was 11.72 mL/kg/min according to transcutaneous partial pressure of oxygen (threshold of 30 mmHg). Receiver operating characteristic curve analyses revealed that the value of tc-artPCO2 for discrimination of DO2crit was highest with an area under the curve (AUC) of 0.94, followed by shock index (AUC = 0.78; P < 0.04 vs tc-artPCO2), and lactate (AUC = 0.65; P < 0.001 vs tc-artPCO2).ConclusionsOur observations suggest the less-invasive tc-artPCO2 monitoring can sensitively detect inadequate systemic oxygen supply during hemorrhagic shock. Further evaluations are required in different forms of shock in other large animal models and in humans to assess its usefulness, safety, and ability to predict outcomes in critical illnesses.
Highlights
Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO2 and Arterial partial pressure of carbon dioxide (artPCO2) with the systemic oxygen metabolism and hemodynamic parameters
The ultimate goal of resuscitation for hemorrhagic shock is the rapid control of the source and the restoration of effective tissue perfusion, oxygenation, and cellular metabolism [2]
Hemodynamics and blood gas analysis Hemorrhage and blood transfusions impacted tcartPCO2, mean arterial pressure (MAP), heart rate, central venous pressure (CVP), shock index (SI), PI, and comprehensive hemodynamic parameters obtained by pulmonary artery catheter (PAC) or pulse index continuous cardiac output (PiCCO), such as cardiac output (CO) and SV (Fig. 2). tc-artPCO2 increased with increased volume of blood withdrawn, tc-artPCO2
Summary
Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO2 and artPCO2 (tc-artPCO2) with the systemic oxygen metabolism and hemodynamic parameters. The pulmonary artery catheter (PAC) provides continuous monitoring of comprehensive hemodynamic parameters, including stroke volume, CO, mixed venous oxygen saturation, and intracardiac pressure, with several additional calculated variables to guide diagnosis and treatment [3]. The pulse index continuous cardiac output (PiCCO) is another efficient and advanced hemodynamic monitoring system that integrates various hemodynamic variables through intra-arterial and central venous catheterization [4]. These techniques are invasive, with no clear evidence of improved outcomes associated with their use to guide therapy [5, 6]
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