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Introduction. Since its first publication in the medical literature, an extremely large number of references have demonstrated that the tonometric measurement of tissue perfusion is a reliable indicator of the actual condition of critically ill patients. Later a new method was developed by the introduction of sublingual tonometry for the determinat...
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Citations
... The stomach is not the only suitable site of the gastrointestinal tract for tissue capnometry. As gastric microcirculation corresponds to the microcirculation of the sublingual region, measuring pCO 2 in the sublingual mucosa appears to be a reasonable alternative to gastric tonometry [121][122][123][124]. The difference between pCO 2 in the sublingual mucosa and arterial pCO 2 is considered to be predictive of mortality in acute circulatory failure, especially with a cutoff level of 70 mmHg [112,125]. ...
The majority of potentially preventable mortality in trauma patients is related to bleeding; therefore, early recognition and effective treatment of hemorrhagic shock impose a cardinal challenge for trauma teams worldwide. The reduction in mesenteric perfusion (MP) is among the first compensatory responses to blood loss; however, there is no adequate tool for splanchnic hemodynamic monitoring in emergency patient care. In this narrative review, (i) methods based on flowmetry, CT imaging, video microscopy (VM), measurement of laboratory markers, spectroscopy, and tissue capnometry were critically analyzed with respect to their accessibility, and applicability, sensitivity, and specificity. (ii) Then, we demonstrated that derangement of MP is a promising diagnostic indicator of blood loss. (iii) Finally, we discussed a new diagnostic method for the evaluation of hemorrhage based on exhaled methane (CH4) measurement. Conclusions: Monitoring the MP is a feasible option for the evaluation of blood loss. There are a wide range of experimentally used methodologies; however, due to their practical limitations, only a fraction of them could be integrated into routine emergency trauma care. According to our comprehensive review, breath analysis, including exhaled CH4 measurement, would provide the possibility for continuous, non-invasive monitoring of blood loss.
... This was the case of a nine-month infant, born with combined congenital cardiac abnormalities, in whom an abrupt increase in gastric PCO 2 was detected during aggressive mechanical ventilation, and was followed by the diagnosis of a severe respiratory complication of tension pneumothorax [11]. In a validation study of a new sublingual capillary tonometer, performed in COPD patients, sublingual PCO2 values decreased in parallel with arterial blood PCO2 during hyperventilation [12]. These observations suggest that in patients without compromised circulation sublingual capnometry may indicate short term changes in arterial PCO2. ...
Mucosal capnometry involves the monitoring of partial pressure of carbon dioxide (PCO2) in mucous membranes. Different techniques have been developed and applied for this purpose, including sublingual or buccal sensors, or special gastrointestinal tonometric devices. The primary use of these procedures is to detect compensated shock in critically ill patients or patients undergoing major surgery. Compensatory mechanisms, in the early phases of shock, lead to the redistribution of blood flow towards the vital organs, within ostensibly typical macro-haemodynamic parameters. Unfortunately, this may result in microcirculatory disturbances, which can play a pivotal role in the development of organ failure. In such circumstances mucosal capnometry monitoring, at different gastrointestinal sites, can provide a sensitive method for the early diagnosis of shock. The special PCO2 monitoring methods assess the severity of ischaemia and help to define the necessary therapeutic interventions and testing of these monitors have justified their prognostic value. Gastrointestinal mucosal capnometry monitoring also helps in determining the severity of ischaemia and is a useful adjunctive in the diagnosis of occlusive splanchnic arterial diseases. The supplementary functional information increases the diagnostic accuracy of radiological techniques, assists in creating individualized treatment plans, and helps in follow-up the results of interventions. The results of a pilot study focusing on the interrelation of splanchnic perfusion and gastrointestinal function are given and discussed concerning recent advances in mucosal capnometry.
... In our institute a special instrument has been designed and manufactured for the measurement of sublingual PCO 2 (Figure 1), which is a further development of a gastric tonometer [15,16]. The performance of this new probe was recently tested in vitro and also in patients with respiratory disease, and the results showed its suitability for sublingual tonometry [17]. ...
Tissue capnometry may be suitable for the indirect evaluation of regional hypoperfusion. We tested the performance of a new sublingual capillary tonometer in experimental hemorrhage. Thirty-six anesthetized, ventilated mini pigs were divided into sham-operated (n=9) and shock groups (n=27). Hemorrhagic shock was induced by reducing mean arterial pressure (MAP) to 40 mmHg for 60 min, after which fluid resuscitation started aiming to increase MAP to 75% of the baseline value (60-180 min). Sublingual carbon-dioxide partial pressure was measured by tonometry, using a specially coiled silicone rubber tube. Mucosal red blood cell velocity (RBCV) and capillary perfusion rate (CPR) were assessed by orthogonal polarization spectral (OPS) imaging. In the 60 min shock phase a significant drop in cardiac index was accompanied by reduction in sublingual RBCV and CPR and significant increase in the sublingual mucosal-to-arterial PCO2 gap (PSLCO2 gap), which significantly improved during the 120 min resuscitation phase. There was significant correlation between PSLCO2 gap and sublingual RBCV (r=-0.65, p<0.0001), CPR (r=-0.64, p<0.0001), central venous oxygen saturation (r=-0.50, p<0.0001), and central venous-to-arterial PCO2 difference (r=0.62, p<0.0001). This new sublingual tonometer may be an appropriate tool for the indirect evaluation of circulatory changes in shock.
