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Sublingual Capnography^*

A Clinical Validation Study

^* From Critical Care Medicine, The Mercy Hospital of Pittsburgh, Pittsburgh, PA.

Correspondence to: Paul Marik, MD, FCCP, Critical Care Medicine, Mercy Hospital of Pittsburgh, 1400 Locust St, Pittsburgh, PA 15219-5166; e-mail: pmarik{at}zbzoom.net

Objective: To compare sublingual PCO₂ (PslCO₂) measurements with gastric intramucosal PCO₂ (PimCO₂) as well as with the traditional indexes of tissue oxygenation in hemodynamically unstable ICU patients.

Design: A prospective, validation study.

Setting: The medical and coronary ICUs of a community teaching hospital.

Patients: Consecutive patients with severe sepsis, septic shock, or cardiogenic shock requiring pulmonary artery catheterization for hemodynamic management.

Interventions: During the first 24 h of ICU admission, the PslCO₂, PimCO₂, and blood lactate concentrations as well conventional hemodynamic and oxygenation parameters were recorded every 4 to 6 h. The PslCO₂-PaCO₂ and PimCO₂-PaCO₂ differences were used as indexes of tissue dysoxia. These variables were correlated with each other as well as with the traditional markers of tissue oxygenation.

Results: Seventy-six data sets were obtained on 22 patients. Fifteen patients had severe sepsis/septic shock, and 7 patients did not have sepsis. A patient with ischemic bowel who had a large PimCO₂-PslCO₂ difference (60.2 mm Hg) was excluded. The initial PslCO₂ and PimCO₂ measurements were 43.5 ± 10.4 mm Hg and 42.8 ± 10.9 mm Hg, respectively (correlation coefficient [r] of 0.86; p < 0.001). The mean PslCO₂ and PimCO₂ for the entire data set were 48.0 ± 13.4 mm Hg and 46.1 ± 12.3 mm Hg, respectively (r = 0.78; p < 0.001). Ten patients died. The initial PslCO₂-PaCO₂ difference was 9.2 ± 5.0 mm Hg in the survivors and 17.8 ± 11.5 mm Hg in the nonsurvivors (p = 0.04). The initial PimCO₂-PaCO₂ difference was 8.4 ± 4.8 mm Hg in the survivors and 16.1 ± 13.7 mm Hg in the nonsurvivors (p = 0.08, not significant). The initial PslCO₂-PaCO₂ difference correlated with the initial mixed venous-arterial CO₂ gradient (r = 0.66; p = 0.001), but correlated poorly with the initial blood lactate concentration (r = 0.38), mixed venous PO₂ (r = 0.05), and systemic oxygen delivery (r = - 0.39).

Conclusion: In this study, sublingual capnometry yielded measurements that correlated well with those of gastric tonometry. PslCO₂ may serve as a technically simple and noninvasive clinical measurement of tissue dysoxia in critically ill and injured patients.

Key Words: gastric tonometry • intramucosal hypercarbia • lactate • pulmonary artery catheter • sublingual capnography • tissue oxygenation

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