End-tidal CO2 pressure determinants during hemorrhagic shock.
OBJECTIVE
To examine the relationship between end-tidal CO2 (PETCO2) and its physiological determinants, pulmonary blood flow (cardiac output, CO) and CO2 production (VCO2), in a model of hemorrhagic shock during fixed minute ventilation.


METHODS
Prospective, observational study in a research laboratory at a university center.


METHODS
Six anesthetized, intubated, and mechanically ventilated mongrel dogs. Progressive stepwise bleeding.


RESULTS
We continuously measured PETCO2 with a capnograph, pulmonary artery blood flow with an electromagnetic flow probe, arterial oxygen saturation (SaO2) with a fiberoptic catheter, and oxygen consumption (VO2) and VCO2 by expired gases analysis. Oxygen delivery (DO2) was continuously calculated from pulmonary blood flow and SaO2. We studied the correlation of PETCO2 with CO and VCO2 in each individual experiment. We also calculated the critical point in the relationships PETCO2/ DO2 and VO2/DO2 by the polynomial method. As expected, PETCO2 was correlated with CO. The best fit was logarithmic in all experiments (median r2 = 0.90), showing that PETCO2 decrease is greater in lowest flow states. PETCO2 was correlated with VCO2, but the best fit was linear (median r2 = 0.77). Critical DO2 for PETCO2 and VO2 was 8.0 +/- 3.3 and 6.3 +/- 2.5 ml x min(-1) kg(-1), respectively (NS).


CONCLUSIONS
Our data reconfirm the relationship between PETCO2 and CO during hemorrhagic shock. The relatively greater decrease in PETCO2 at lowest CO levels could represent diminished CO2 production during the period of VO2 supply dependency.
Dubin
A
A
Cátedra de Farmacología, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Argentina. adee@infovia.com.ar
Murias
G
G
Estenssoro
E
E
Canales
H
H
Sottile
P
P
Badie
J
J
Barán
M
M
Rossi
S
S
Laporte
M
M
Pálizas
F
F
Giampieri
J
J
Mediavilla
D
D
Vacca
E
E
Botta
D
D
D000818:Animals; D001783:Blood Flow Velocity; D019296:Capnography / Q000379:methods*; D002245:Carbon Dioxide / Q000378:metabolism*; D002302:Cardiac Output; D004285:Dogs; D011446:Prospective Studies; D011651:Pulmonary Artery; D012121:Respiration, Artificial; D015656:Respiratory Mechanics; D012771:Shock, Hemorrhagic / Q000503:physiopathology*; D018709:Statistics, Nonparametric
D002245:Carbon Dioxide