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Sublingual Capnometry and Indexes of Tissue Perfusion in Patients With Circulatory Failure^*

^* From Saint Vincents Hospital and Medical Center, New York, NY.

Correspondence to: Mark E. Astiz, MD, FCCP, Department of Medicine, Saint Vincents Hospital and Medical Center, 153 W 11th St, New York, NY 10011; e-mail: meastiz{at}aol.com

Objective: To examine the relationship between sublingual PCO₂ (PslCO₂) and other indexes of tissue perfusion.

Design: Prospective observational study.

Setting: Medical and coronary ICUs in a tertiary-care teaching hospital.

Subjects: Twenty-five patients with circulatory failure, 19 patients with sepsis, and 6 patients with cardiac failure.

Measurements and main results: PslCO₂, gastric intramucosal PCO₂ (PiCO₂), arterial lactate concentration, systemic oxygen delivery, and systemic oxygen consumption were measured at baseline and at 1, 3, 6, 12, and 24 h after the beginning of the study. PslCO₂ and the PslCO₂-PaCO₂ gradient were increased but not significantly different in nonsurvivors compared to survivors at baseline. At 24 h, the mean (± SE) PslCO₂ was 45 ± 4 mm Hg in survivors and 61 ± 4 mm Hg in nonsurvivors (p = 0.06), while the PslCO₂-PaCO₂ gradient was 14 ± 3 mm Hg in survivors and 29 ± 4 mm Hg in nonsurvivors (p < 0.05). No other significant differences in survivors and nonsurvivors were observed in any other index of perfusion. For all patients, the correlations between PslCO₂ and PiCO₂ (r = 0.459; p < 0.05) and cardiac index (r = 0.285; p < 0.05) were observed. The PslCO₂-PaCO₂ gradient also was correlated with the PiCO₂-PaCO₂ gradient (r = 0.323; p < 0.05). When patients were placed into subsets of sepsis and cardiac failure, the strength of the correlations increased in the patients with cardiac failure (PslCO₂ vs lactate, r = 0.611 and p < 0.05; PslCO₂ vs PiCO₂, r = 0.613 and p < 0.05; PslCO₂ vs PiCO₂-PaCO₂ gradient, r = 0.648 and p < 0.05).

Conclusion: PslCO₂ correlated best with PiCO₂ and arterial lactate concentration in patients with cardiac failure. PslCO₂ and the PslCO₂-PaCO₂ gradient may be useful as indexes of the severity of perfusion failure.

Key Words: carbon dioxide • circulatory shock • gastric tonometry • lactate • sublingual capnometry

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