Gastric tonometry in patients with cardiogenic shock and intra-aortic balloon counterpulsation.
OBJECTIVE
To study the course of gastric regional PCO2 (PrCO2) in patients with cardiogenic shock requiring intra-aortic balloon (IAB) counterpulsation and the prognostic value of PrCO2 in this patient population.


METHODS
A prospective, observational clinical study.


METHODS
Medical intensive care unit in a university hospital.


METHODS
Twenty-six consecutive patients with cardiogenic shock requiring mechanical support with an IAB counterpulsation undergoing mechanical ventilation


METHODS
None.


RESULTS
Hemodynamic variables, tonometric variables, arterial blood gases, and arterial lactate were assessed before insertion of IAB (baseline), and 1, 2, 3, 8, 16, 24, and 48 hrs thereafter. A subset of these patients (n = 14) were studied just before and 1, 8, 24, and 32 hrs after IAB removal; 12/26 patients (46.2%) died. Cardiac index increased from baseline to 1 hr after insertion of IAB (1.7 +/- 0.3 to 2.6 +/- 0.8 L/min/m2, p < .05). PrCO2 did not change between admission (47 +/- 13 torr [6.3 +/- 1.7 kPa]) and 8 hrs after placement of IAB but increased to 63 +/- 22 torr (8.4 +/- 2.9 kPa) at 16 hrs (p < .05) without any further alteration until 48 hrs. CO2 gap showed a similar pattern with 15 +/- 11 torr (2.0 +/- 1.5 kPa) at baseline and an increase to 28 +/- 22 torr (3.7 +/- 2.9 kPa) 16 hrs later. PrCO2 and CO2 gap remained at high levels (59 +/- 11 torr [7.7 +/- 1.5 kPa] and 22 +/- 10 torr [2.9 +/- 1.3 kPa], respectively), before IAB removal without further improvement or deterioration thereafter. PrCO2 values showed no difference between survivors and nonsurvivors at any time point.


CONCLUSIONS
Patients with cardiogenic shock developed high PrCO2 within the first 24 hrs, which reflects gastric mucosal ischemia. Persistently high levels of PrCO2 were indicative for prolonged hypoperfusion of the gut. Gastric tonometry failed to discriminate between survivors and nonsurvivors.
Janssens
U
U
Medical Clinic I, University of Aachen, Germany.
Graf
J
J
Koch
K C
KC
vom Dahl
J
J
Hanrath
P
P
D000368:Aged; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000032:analysis*; D016002:Discriminant Analysis; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply*; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000401:mortality; D007511:Ischemia / Q000209:etiology* / Q000378:metabolism* / Q000503:physiopathology; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000150:complications* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013152:Splanchnic Circulation; D016019:Survival Analysis; D013997:Time Factors
D002245:Carbon Dioxide; D019344:Lactic Acid