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Titolo:
Changes in p(i)CO(2) reflect splanchnic mucosal ischaemia more reliably than changes in pH(i) during haemorrhagic shock
Autore:
Meisner, FG; Habler, OP; Kemming, GI; Kleen, MS; Pape, A; Messmer, K;
Indirizzi:
Univ Munich Clin, Inst Surg Res, D-81377 Munich, Germany Univ Munich ClinMunich Germany D-81377 urg Res, D-81377 Munich, Germany Univ Munich, Clin Anaesthesiol, Grosshedern, Germany Univ Munich Grosshedern Germany Clin Anaesthesiol, Grosshedern, Germany
Titolo Testata:
LANGENBECKS ARCHIVES OF SURGERY
fascicolo: 5, volume: 386, anno: 2001,
pagine: 333 - 338
SICI:
1435-2443(200108)386:5<333:CIPRSM>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
GASTRIC INTRAMUCOSAL PH; OXYGEN-DERIVED VARIABLES; CRITICALLY ILL PATIENTS; TISSUE OXYGENATION; INTRAMURAL PH; HEMORRHAGIC-SHOCK; TONOMETRY; PCO2; MORTALITY; COMPLICATIONS;
Keywords:
gastric tonometry; pH(i); p(i)CO(2); [H+] gap; pCO(2) gap; haemorrhagic shock; shock; monitoring; metabolism; gastric mucosa; blood gas analysis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Meisner, FG Univ Munich Clin, Inst Surg Res, Grosshadern Marchioninistr 15, D-81377 Munich, Germany Univ Munich Clin Grosshadern Marchioninistr 15 Munich Germany D-81377
Citazione:
F.G. Meisner et al., "Changes in p(i)CO(2) reflect splanchnic mucosal ischaemia more reliably than changes in pH(i) during haemorrhagic shock", LANG ARCH S, 386(5), 2001, pp. 333-338

Abstract

Background: Gastric tonometry is intended to reveal alterations in splanchnic perfusion and oxygenation. Based on the tonometric measurement of gastric mucosal partial pressure of carbon dioxide (PCO2) and the simultaneous determination of arterial blood gas parameters (bicarbonate concentration [HCO3-] pH and pCO(2)), several parameters can be calculated. Aims: To identify the most suitable tonometric parameter [gastric mucosal pH (pH(i)), intramucosal PCO2 (p(i)CO(2)), the difference between tonometric and arterial pCO(2) concentrations (PCO2 gap), [H+] gap] that reliably reflects gastric hypoperfusion and hypoxia during severe haemorrhagic shock. Design: Randomised, controlled experimental study. Methods: An artificial stenosis of the left anterior descending coronary artery (LAD) was induced. Subsequently, the animals were haemorrhaged to a mean arterial pressure of 45 mmHg, which was maintained for 60 min. Measurements and main results: Tonometric measurements were performed in 17 land-race pigs before and after induction of LADstenosis and after haemorrhagic shock. P values obtained using the Wilcoxon signed-rank testing were used to compare the level of significance for the tonometric parameters and the corresponding arterial blood gas values [arterial pCO(2) (PaCO2), [HCO3-], arterial pH (pH,)]. While induction of critical coronary stenosis did not provoke any changes, all parameters changed significantly during haemorrhagic shock. The lowest P value was found for pHi (P=0.00013) followed by [H+ gap] (P=0.0005). P values higher by a factorof ten were found for PCO2 gap (P=0.00119) and were highest for PiCO2 (P=0.00562). P values of the corresponding arterial blood gas parameters were lower by a factor of ten than the P value of PiCO2. Conclusion: pH(i), PCO2 gap and [H+] gap are considerably influenced by changes of systemic arterial blood gas values. This is demonstrated by lower P values of the corresponding arterial blood gas values in comparison with PiCO2. Therefore pHi, PCO2 gap and [H+] gap seem to indicate more likely systemic changes, whereas PiCO2 appears to reflect disturbances of regional gastric tissue perfusion and oxygenation more reliably than any other derived tonometric parameter.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/01/20 alle ore 06:26:41