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INNOVATIVE METHODOLOGY

Buccal capnometry to guide management of massive blood loss

¹Weil Institute of Critical Care Medicine, Rancho Mirage; and ²The Keck School of Medicine, University of Southern California, Los Angeles, California

Submitted 5 November 2004 ; accepted in final form 15 August 2005

In both clinical and experimental settings, tissue PCO₂ measured in the oral mucosa is a practical and reliable measurement of the severity of hypoperfusion. We hypothesized that a threshold level of buccal tissue PCO₂ (PCO_{2 BU}) would prognosticate the effects of volume repletion on survival. Twenty pentobarbital-anesthetized Sprague-Dawley male breeder rats, each weighing 0.5 kg, were randomly assigned to one of four groups. Animals were bled over an interval of 30 min in amounts estimated to be 25, 30, 35, or 40% of total blood volume. One-half hour after the completion of bleeding, each animal received an infusion of Ringer lactate solution over the ensuing 30 min in amounts equivalent to two times the volume of blood loss. PCO_{2 BU} was measured continuously with an optical PCO₂ sensor applied noninvasively to the mucosa of the left cheek. Arterial pressure and end-tidal CO₂ were measured over the same interval. Neurological deficit and 72-h survival were recorded. Aortic pressures were restored to near baseline values for each of the four groups after fluid resuscitation. This contrasted with the improvement of PCO_{2 BU}, which differentiated between animals with short and long durations of postintervention survival. After electrolyte fluid resuscitation in rats subjected to rapid bleeding, noninvasive measurement of PCO_{2 BU} was predictive of outcomes. Neither noninvasive end-tidal PCO₂ nor invasive aortic pressure measurements achieved such discrimination. Accordingly, PCO_{2 BU} fulfills the criterion of a noninvasive and reliable measurement to guide fluid management of hemorrhagic shock.

hypoperfusion; tissue hypercarbia