Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model

Abstract Background Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient betwe...

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Autores principales:	Yusuke Endo, Taku Hirokawa, Taku Miyasho, Ryosuke Takegawa, Koichiro Shinozaki, Daniel M. Rolston, Lance B. Becker, Kei Hayashida
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Hemorrhage Hemorrhagic shock Resuscitation Transcutaneous partial pressure monitoring of carbon dioxide partial pressure Transcutaneous partial pressure monitoring of oxygen Catheterization Medicine R
Acceso en línea:	https://doaj.org/article/2ae9937a1d99490da6ff835f2f18e9e1
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spelling	oai:doaj.org-article:2ae9937a1d99490da6ff835f2f18e9e12021-11-14T12:08:17ZMonitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model10.1186/s12967-021-03060-51479-5876https://doaj.org/article/2ae9937a1d99490da6ff835f2f18e9e12021-11-01T00:00:00Zhttps://doi.org/10.1186/s12967-021-03060-5https://doaj.org/toc/1479-5876Abstract Background Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO2 and artPCO2 (tc-artPCO2) with the systemic oxygen metabolism and hemodynamic parameters. Our study aimed to test the hypothesis that tc-artPCO2 can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation. Methods This prospective animal study was performed using female pigs at a university-based experimental laboratory. Progressive massive hemorrhagic shock was induced in mechanically ventilated pigs by stepwise blood withdrawal. All animals were then resuscitated by transfusing the stored blood in stages. A transcutaneous monitor was attached to their ears to measure tcPCO2. A pulmonary artery catheter (PAC) and pulse index continuous cardiac output (PiCCO) were used to monitor cardiac output (CO) and several hemodynamic parameters. The relationships of tc-artPCO2 with the study parameters and systemic oxygen delivery (DO2) were analyzed. Results Hemorrhage and blood transfusion precisely impacted hemodynamic and laboratory data as expected. The tc-artPCO2 level markedly increased as CO decreased. There were significant correlations of tc-artPCO2 with DO2 and COs (DO2: r = − 0.83, CO by PAC: r = − 0.79; CO by PiCCO: r = − 0.74; all P < 0.0001). The critical level of oxygen delivery (DO2crit) was 11.72 mL/kg/min according to transcutaneous partial pressure of oxygen (threshold of 30 mmHg). Receiver operating characteristic curve analyses revealed that the value of tc-artPCO2 for discrimination of DO2crit was highest with an area under the curve (AUC) of 0.94, followed by shock index (AUC = 0.78; P < 0.04 vs tc-artPCO2), and lactate (AUC = 0.65; P < 0.001 vs tc-artPCO2). Conclusions Our observations suggest the less-invasive tc-artPCO2 monitoring can sensitively detect inadequate systemic oxygen supply during hemorrhagic shock. Further evaluations are required in different forms of shock in other large animal models and in humans to assess its usefulness, safety, and ability to predict outcomes in critical illnesses.Yusuke EndoTaku HirokawaTaku MiyashoRyosuke TakegawaKoichiro ShinozakiDaniel M. RolstonLance B. BeckerKei HayashidaBMCarticleHemorrhageHemorrhagic shockResuscitationTranscutaneous partial pressure monitoring of carbon dioxide partial pressureTranscutaneous partial pressure monitoring of oxygenCatheterizationMedicineRENJournal of Translational Medicine, Vol 19, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hemorrhage Hemorrhagic shock Resuscitation Transcutaneous partial pressure monitoring of carbon dioxide partial pressure Transcutaneous partial pressure monitoring of oxygen Catheterization Medicine R
spellingShingle	Hemorrhage Hemorrhagic shock Resuscitation Transcutaneous partial pressure monitoring of carbon dioxide partial pressure Transcutaneous partial pressure monitoring of oxygen Catheterization Medicine R Yusuke Endo Taku Hirokawa Taku Miyasho Ryosuke Takegawa Koichiro Shinozaki Daniel M. Rolston Lance B. Becker Kei Hayashida Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model
description	Abstract Background Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO2 and artPCO2 (tc-artPCO2) with the systemic oxygen metabolism and hemodynamic parameters. Our study aimed to test the hypothesis that tc-artPCO2 can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation. Methods This prospective animal study was performed using female pigs at a university-based experimental laboratory. Progressive massive hemorrhagic shock was induced in mechanically ventilated pigs by stepwise blood withdrawal. All animals were then resuscitated by transfusing the stored blood in stages. A transcutaneous monitor was attached to their ears to measure tcPCO2. A pulmonary artery catheter (PAC) and pulse index continuous cardiac output (PiCCO) were used to monitor cardiac output (CO) and several hemodynamic parameters. The relationships of tc-artPCO2 with the study parameters and systemic oxygen delivery (DO2) were analyzed. Results Hemorrhage and blood transfusion precisely impacted hemodynamic and laboratory data as expected. The tc-artPCO2 level markedly increased as CO decreased. There were significant correlations of tc-artPCO2 with DO2 and COs (DO2: r = − 0.83, CO by PAC: r = − 0.79; CO by PiCCO: r = − 0.74; all P < 0.0001). The critical level of oxygen delivery (DO2crit) was 11.72 mL/kg/min according to transcutaneous partial pressure of oxygen (threshold of 30 mmHg). Receiver operating characteristic curve analyses revealed that the value of tc-artPCO2 for discrimination of DO2crit was highest with an area under the curve (AUC) of 0.94, followed by shock index (AUC = 0.78; P < 0.04 vs tc-artPCO2), and lactate (AUC = 0.65; P < 0.001 vs tc-artPCO2). Conclusions Our observations suggest the less-invasive tc-artPCO2 monitoring can sensitively detect inadequate systemic oxygen supply during hemorrhagic shock. Further evaluations are required in different forms of shock in other large animal models and in humans to assess its usefulness, safety, and ability to predict outcomes in critical illnesses.
format	article
author	Yusuke Endo Taku Hirokawa Taku Miyasho Ryosuke Takegawa Koichiro Shinozaki Daniel M. Rolston Lance B. Becker Kei Hayashida
author_facet	Yusuke Endo Taku Hirokawa Taku Miyasho Ryosuke Takegawa Koichiro Shinozaki Daniel M. Rolston Lance B. Becker Kei Hayashida
author_sort	Yusuke Endo
title	Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model
title_short	Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model
title_full	Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model
title_fullStr	Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model
title_full_unstemmed	Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model
title_sort	monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model
publisher	BMC
publishDate	2021
url	https://doaj.org/article/2ae9937a1d99490da6ff835f2f18e9e1
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Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model

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