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Departments of Anesthesiology and Critical Care Medicine, Internal Medicine, and Surgery, University of Pittsburgh, and Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240
Received 4 November 1994; accepted in final form 13 May 1996.
Rozenfeld, Ranna A., Michael K. Dishart, Tor Inge
Tønnessen, and Robert Schlichtig. Methods for detecting local
intestinal ischemic anaerobic metabolic acidosis by
PCO2. J. Appl. Physiol. 81(4): 1834-1842, 1996.
Gut ischemia is
often assessed by computing an imaginary tissue interstitial pH from
arterial plasma HCO
3 and the
PCO2 in a saline-filled balloon
tonometer after equilibration with tissue
PCO2 (PtiCO2).
PtiCO2 may
alternatively be assumed equal to venous PCO2
(PvCO2) in that region of gut. The idea
is that as blood flow decreases, gut
PtiCO2 and
PvCO2 will increase to the maximum
aerobic value, i.e., maximum respiratory
PvCO2
(PvCO2 rmax). Above a "critical" anaerobic threshold, lactate
(La) generation, by
titration of tissue HCO3, should raise
PtiCO2
above
PvCO2 rmax.
During progressive selective whole intestinal flow reduction in
six pentobarbital-anesthetized pigs, we used
PCO2 electrodes to test the
hypotheses that critical
PtiCO2
is achieved earlier in mucosa than in serosa and that
PvCO2 rmax,
computed using an in vitro model, predicts critical
PtiCO2. We
defined critical
PtiCO2 as the
inflection of
PtiCO2-PvCO2
vs. O2 delivery
(
O2)
plots. Critical
O2
for O2 uptake was 12.55 ± 2 ml · kg1 · min1.
Critical PtiCO2 for mucosa
and serosa was achieved at similar whole intestine
O2
(13.90 ± 5 and 13.36 ± 5 ml · kg1 · min1,
P = NS). Critical
PtiCO2 (129 ± 24 and 96 ± 21 Torr) exceeded PvCO2 rmax
(62 ± 3 Torr). During ischemia,
La excretion into portal
venous blood was matched by K+
excretion, causing PvCO2 to increase
only slightly, despite
PtiCO2 rising
to 380 ± 46 (mucosa) and 280 ± 38 (serosa) Torr. These results
suggest that mucosa and serosa become dysoxic simultaneously, that
ischemic dysoxic gut is essentially unperfused, and that in vitro
predicted
PvCO2 rmax
underestimates critical
PtiCO2.
ischemia; acidosis; carbon dioxide; hypercarbia; strong ion difference
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