Monitoring Microcirculatory Blood Flow with a New Sublingual Tonometer in a Porcine Model of Hemorrhagic Shock.
Tissue capnometry may be suitable for the indirect evaluation of regional hypoperfusion. We tested the performance of a new sublingual capillary tonometer in experimental hemorrhage. Thirty-six anesthetized, ventilated mini pigs were divided into sham-operated (n = 9) and shock groups (n = 27). Hemorrhagic shock was induced by reducing mean arterial pressure (MAP) to 40 mmHg for 60 min, after which fluid resuscitation started aiming to increase MAP to 75% of the baseline value (60-180 min). Sublingual carbon-dioxide partial pressure was measured by tonometry, using a specially coiled silicone rubber tube. Mucosal red blood cell velocity (RBCV) and capillary perfusion rate (CPR) were assessed by orthogonal polarization spectral (OPS) imaging. In the 60 min shock phase a significant drop in cardiac index was accompanied by reduction in sublingual RBCV and CPR and significant increase in the sublingual mucosal-to-arterial PCO2 gap (PSLCO2 gap), which significantly improved during the 120 min resuscitation phase. There was significant correlation between PSLCO2 gap and sublingual RBCV (r = -0.65, p < 0.0001), CPR (r = -0.64, p < 0.0001), central venous oxygen saturation (r = -0.50, p < 0.0001), and central venous-to-arterial PCO2 difference (r = 0.62, p < 0.0001). This new sublingual tonometer may be an appropriate tool for the indirect evaluation of circulatory changes in shock.
Department of Anesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Péter
P
Palágyi
Institute of Surgical Research, University of Szeged, 6 Szőkefalvi-Nagy Béla Street, Szeged 6720, Hungary.
József
J
Kaszaki
Institute of Surgical Research, University of Szeged, 6 Szőkefalvi-Nagy Béla Street, Szeged 6720, Hungary.
Andrea
A
Rostás
Institute of Surgical Research, University of Szeged, 6 Szőkefalvi-Nagy Béla Street, Szeged 6720, Hungary.
Dániel
D
Érces
Department of Anesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Márton
M
Németh
Institute of Surgical Research, University of Szeged, 6 Szőkefalvi-Nagy Béla Street, Szeged 6720, Hungary.
Mihály
M
Boros
Department of Anesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Zsolt
Z
Molnár
D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D008365:Manometry / Q000295:instrumentation* / Q000379:methods; D008833:Microcirculation / Q000502:physiology*; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D009060:Mouth Floor / Q000098:blood supply / Q000502:physiology; D012771:Shock, Hemorrhagic / Q000503:physiopathology*; D013552:Swine