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Program of Critical Care Medicine, Department of Surgery and Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada V6Z 1Y6
Gastric tonometer
PCO2 measurement may help identify
gut ischemia in critically ill patients but is frequently
associated with large measurement errors. We tested the hypothesis that
small bowel tonometer PCO2
measurement yields more accurate information. In 10 anesthetized,
mechanically ventilated pigs subject to progressive hemorrhage, we
measured gut oxygen delivery and consumption. We also measured
tonometer PCO2 minus arterial
PCO2
(
PCO2) and calculated the corresponding intracellular pH from tonometers placed in the stomach and jejunum. We found that the correlation coefficient
(r2) for
biphasic gut oxygen delivery-PCO2
relationships was 0.29 ± 0.52 for the gastric tonometer vs. 0.76 ± 0.25 for the small bowel tonometer
(P < 0.05). In addition, the
critical gastric tonometer PCO2
was excessively high and variable (62.9 ± 39.6) compared with the
critical small bowel tonometer
PCO2 (17.0 ± 15.0, P < 0.01). Small bowel tonometer
PCO2 was closely correlated with
superior mesenteric vein PCO2
(r2 = 0.81, P < 0.001), whereas gastric
tonometer PCO2 was not
(r2 = 
0.13, P = not significant). We
conclude that measurement of gastric tonometer
PCO2 yields excessively noisy and
inaccurate data on the onset of gut anaerobic metabolism in hemorrhagic
shock. Small bowel tonometer PCO2 is
less noisy and, as a result, is superior in detecting gut hypoperfusion
and the onset of anaerobic metabolism.
gastric tonometry; small bowel tonometry; intracellular pH; mesenteric ischemia
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