Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model.
Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model.
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DOI：
10.1186/s12967-021-03060-5
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发表时间：
2021-11-14
影响因子：
7.4
通讯作者：
Hayashida K
中科院分区：
文献类型：
--
作者：
Endo Y;Hirokawa T;Miyasho T;Takegawa R;Shinozaki K;Rolston DM;Becker LB;Hayashida K
尽管有许多证据支持监测经皮二氧化碳分压（tcPCO 2）与动脉二氧化碳分压（artPCO 2）的差异作为休克状态的指标，但关于tcPCO 2和artPCO 2（tc-artPCO 2）之间的梯度与全身氧代谢和血流动力学参数的关系的数据有限。我们的研究旨在验证tc-artPCO 2可以检测出血性休克和复苏过程中组织灌注不足的假设。这项前瞻性动物研究是在一所大学的实验室中使用母猪进行的。在机械通气的猪中通过逐步抽血诱导进行性大量失血性休克。然后通过分阶段使用储存的血液复苏所有动物。将经皮监测器连接到他们的耳朵上以测量tcPCO 2。使用肺动脉导管（PAC）和脉搏指数连续心输出量（PiCCO）监测心输出量（CO）和一些血流动力学参数。分析tc-artPCO 2与研究参数和全身氧供（DO 2）的关系。正如预期，出血和输血精确地影响了血流动力学和实验室数据。tc-artPCO_2水平随CO减少而明显升高。tc-artPCO 2与DO 2和CO具有显著相关性（DO 2：r =-0.83，PAC测定的CO：r =-0.79; PiCCO测定的CO：r =-0.74;所有P < 0.0001）。根据经皮氧分压（阈值为30 mmHg），氧输送临界水平（DO 2crit）为11.72 mL/kg/min。受试者工作特征曲线分析显示，tc-artPCO 2用于区分DO 2crit的值最高，曲线下面积（AUC）为0.94，其次是休克指数（AUC = 0.78; P < 0.04 vs tc-artPCO 2）和乳酸（AUC = 0.65; P < 0.001 vs tc-artPCO 2）。我们的观察表明，微创tc-artPCO 2监测可以敏感地检测失血性休克时全身氧供应不足。需要在其他大型动物模型和人类中对不同形式的休克进行进一步评估，以评估其有效性，安全性和预测危重疾病结局的能力。
Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO2 and artPCO2 (tc-artPCO2) with the systemic oxygen metabolism and hemodynamic parameters. Our study aimed to test the hypothesis that tc-artPCO2 can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation. This prospective animal study was performed using female pigs at a university-based experimental laboratory. Progressive massive hemorrhagic shock was induced in mechanically ventilated pigs by stepwise blood withdrawal. All animals were then resuscitated by transfusing the stored blood in stages. A transcutaneous monitor was attached to their ears to measure tcPCO2. A pulmonary artery catheter (PAC) and pulse index continuous cardiac output (PiCCO) were used to monitor cardiac output (CO) and several hemodynamic parameters. The relationships of tc-artPCO2 with the study parameters and systemic oxygen delivery (DO2) were analyzed. Hemorrhage and blood transfusion precisely impacted hemodynamic and laboratory data as expected. The tc-artPCO2 level markedly increased as CO decreased. There were significant correlations of tc-artPCO2 with DO2 and COs (DO2: r = − 0.83, CO by PAC: r = − 0.79; CO by PiCCO: r = − 0.74; all P < 0.0001). The critical level of oxygen delivery (DO2crit) was 11.72 mL/kg/min according to transcutaneous partial pressure of oxygen (threshold of 30 mmHg). Receiver operating characteristic curve analyses revealed that the value of tc-artPCO2 for discrimination of DO2crit was highest with an area under the curve (AUC) of 0.94, followed by shock index (AUC = 0.78; P < 0.04 vs tc-artPCO2), and lactate (AUC = 0.65; P < 0.001 vs tc-artPCO2). Our observations suggest the less-invasive tc-artPCO2 monitoring can sensitively detect inadequate systemic oxygen supply during hemorrhagic shock. Further evaluations are required in different forms of shock in other large animal models and in humans to assess its usefulness, safety, and ability to predict outcomes in critical illnesses.
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影响因子：
0.6
作者：
ALLGOWER, M;BURRI, C
通讯作者：
BURRI, C
DOI：
10.1016/j.injury.2008.07.032
发表时间：
2009-01-01
影响因子：
2.5
作者：
Sammour, Tarik;Kahokehr, Arman;Hill, Andrew G.
通讯作者：
Hill, Andrew G.
影响因子：
3.3
作者：
Rozenfeld, RA;Dishart, MK;Schlichtig, R
通讯作者：
Schlichtig, R
影响因子：
2
作者：
BINDER, N;ATHERTON, H;HOATH, SB
通讯作者：
HOATH, SB
影响因子：
3
作者：
MAXWELL, TM;LIM, RC;HUNT, TK
通讯作者：
HUNT, TK