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Comparisons Between Sublingual and Gastric Tonometry During Hemorrhagic Shock^*

^* From the Institute of Critical Care Medicine (Drs. Povoas, Weil, Tang, and Kamohara and Mr. Bisera), Palm Springs, CA; and Optical Sensors Inc (Mr. Moran), Minneapolis, MN.

Correspondence to: Max Harry Weil, MD, PhD, Master FCCP, The Institute of Critical Care Medicine, 1695 North Sunrise Way, Building 3, Palm Springs, CA 92262-5309; e-mail: Weilm{at}aol.com

Study objectives: To compare sublingual tissue PCO₂, a disarmingly simple and noninvasive measurement of the severity of perfusion failure, with gastric tonometric PCO₂ during hemorrhagic shock in five male domestic pigs weighing between 35 and 40 kg.

Design: Prospective animal study.

Setting: Animal laboratory in a research institution.

Participants: Domestic pigs.

Interventions: Hemorrhagic shock was induced by a modification of the Wigger’s method. BP was maintained at 50 mm Hg for 120 min followed by reinfusion of shed blood at a rate of 100 mL/min with the aid of an infusion pump.

Measurements and results: During bleeding, the mean arterial pressure decreased from an average of 127 to 42 mm Hg, and cardiac output decreased from 7.7 to 2.4 L/min. Arterial blood lactate concentration concurrently increased from 1.2 to 13.9 mmol/L. Sublingual PCO₂ (PslCO₂) increased from 59 to 105 mm Hg, and gastric PCO₂ increased from 61 to 111 mm Hg. The correlation between time-coincident sublingual and gastric measurements of PCO₂ was r = 0.91 (p < 0.0001). Bland-Altman analyses demonstrated a close correspondence between the two measurements. The reinfusion of shed blood promptly reversed the hemodynamic abnormalities and reestablished gastric and PslCO₂ to near baseline values. This contrasted with a delayed reversal of lactic acidosis.

Conclusions: Under experimental conditions of hemorrhagic shock, sublingual capnometry yielded measurements that were interchangeable with those of gastric tonometry.

Key Words: carbon dioxide tension • gastric tonometry • hemorrhagic shock • sublingual capnometry

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