Gut mucosal-arterial Pco2 gradient as an indicator of splanchnic perfusion during systemic hypo- and hypercapnia.
OBJECTIVE
By accounting for influences of systemic acid-base disturbances, gut mucosal-arterial Pco2 gradient (Pico2 - Paco2) has been increasingly advocated as a more specific marker of splanchnic perfusion than Pico2 alone. We examined the stability of the Pico2 - Paco2 gradient compared with raw Pico2 measurements during induced systemic hypo- and hypercapnia.


METHODS
A prospective animal study.


METHODS
A university research laboratory.


METHODS
Twenty anesthetized, paralyzed, and mechanically ventilated mongrel dogs.


METHODS
After a baseline period during which Paco2 was maintained near 40 torr, the animals were divided into four groups. Minute ventilation was then altered by adjusting tidal volume, frequency, or both to achieve group Paco2 values of 15, 20, 60, and 80 torr for groups 1 through 4, respectively. Portal blood flow was monitored and maintained near baseline levels by infusion of intravenous fluids. Intestinal Pico2 was measured continuously by using capnometric recirculating gas tonometry.


RESULTS
Mean (+/- SE) aggregate baseline Pico2 - Paco2 was 16.9+/-3.3 torr. After 60 mins of hypoventilation, Pico2 - Paco2 decreased to 14.2+/-1.1 and to 13.7+/-2.7 torr in groups 3 and 4, respectively (p = NS, compared with baseline for both). On the other hand, after 60 mins of hyperventilation, Pico2 - Paco2 increased to 37.9+/-3.6 and 28.0+/-6.3 torr in groups 1 and 2, respectively (p < .0001, compared with baseline for both).


CONCLUSIONS
In this model of maintained portal blood flow, Pico2 - Paco2 remained essentially stable after hypoventilation but increased significantly after inducing hyperventilation. Our findings warrant cautious interpretation of Pico2 - Paco2 as an indicator of splanchnic perfusion during systemic hypocapnia.
Guzman
J A
JA
Section of Critical Care Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Kruse
J A
JA
D000818:Animals; D001639:Bicarbonates / Q000378:metabolism* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000378:metabolism* / Q000494:pharmacology; D004285:Dogs; D006935:Hypercapnia / Q000378:metabolism*; D006985:Hyperventilation; D016857:Hypocapnia / Q000378:metabolism*; D007040:Hypoventilation; D007413:Intestinal Mucosa / Q000187:drug effects / Q000378:metabolism*; D012121:Respiration, Artificial; D013152:Splanchnic Circulation / Q000187:drug effects
D001639:Bicarbonates; D002245:Carbon Dioxide