Sublingual capnometry for diagnosis and quantitation of circulatory shock.

Abstract

We investigated sublingual tissue PCO2 during hemorrhagic and septic shock. Hemorrhagic shock was induced in 10 rats. Sublingual PCO2 increased from 45 to 125 mm Hg and arterial pressure declined from 138 to 49 mm Hg, end-tidal PCO2 decreased from 35 to 13 mm Hg, and cardiac index fell from 290 to 77 ml/min/kg. Arterial blood lactate increased from 0.9 to 15.8 mmol/L. Gastric PCO2 was measured in five animals and it increased from 46 to 87 mm Hg. No significant changes were observed in eight "sham" bled animals including the five animals in which gastric PCO2 was measured. Highly significant linear correlations (p < 0.001) between sublingual PCO2 and gastric PCO2 (r = 0.71), cardiac index (r = -0.74), and arterial lactate (r = 0.59) were documented. We subsequently investigated sublingual PCO2 in five animals in which sepsis was induced by intravenous infusion of live Staphylococcus aureus. Like hemorrhagic shock, highly significant linear correlations were observed between end-tidal PCO2 and cardiac index and between sublingual PCO2 and arterial blood lactate. Sublingual PCO2 promises to serve as a technically simple, noninvasive, and rapid response quantitator of severity of circulatory shock states.