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Clinical Investigations in Critical Care |

Sublingual Capnometry and Indexes of Tissue Perfusion in Patients With Circulatory Failure*

Eric C. Rackow, MD, FCCP; Patricia O’Neil, RN; Mark E. Astiz, MD, FCCP; Charles M. Carpati, MD
Author and Funding Information

*From Saint Vincents Hospital and Medical Center, New York, NY.

Correspondence to: Mark E. Astiz, MD, FCCP, Department of Medicine, Saint Vincents Hospital and Medical Center, 153 W 11th St, New York, NY 10011; e-mail: meastiz@aol.com



Chest. 2001;120(5):1633-1638. doi:10.1378/chest.120.5.1633
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Objective: To examine the relationship between sublingual Pco2 (Pslco2) and other indexes of tissue perfusion.

Design: Prospective observational study.

Setting: Medical and coronary ICUs in a tertiary-care teaching hospital.

Subjects: Twenty-five patients with circulatory failure, 19 patients with sepsis, and 6 patients with cardiac failure.

Measurements and main results: Pslco2, gastric intramucosal Pco2 (Pico2), arterial lactate concentration, systemic oxygen delivery, and systemic oxygen consumption were measured at baseline and at 1, 3, 6, 12, and 24 h after the beginning of the study. Pslco2 and the Pslco2-Paco2 gradient were increased but not significantly different in nonsurvivors compared to survivors at baseline. At 24 h, the mean (± SE) Pslco2 was 45 ± 4 mm Hg in survivors and 61 ± 4 mm Hg in nonsurvivors (p = 0.06), while the Pslco2-Paco2 gradient was 14 ± 3 mm Hg in survivors and 29 ± 4 mm Hg in nonsurvivors (p < 0.05). No other significant differences in survivors and nonsurvivors were observed in any other index of perfusion. For all patients, the correlations between Pslco2 and Pico2 (r = 0.459; p < 0.05) and cardiac index (r = 0.285; p < 0.05) were observed. The Pslco2-Paco2 gradient also was correlated with the Pico2-Paco2 gradient (r = 0.323; p < 0.05). When patients were placed into subsets of sepsis and cardiac failure, the strength of the correlations increased in the patients with cardiac failure (Pslco2 vs lactate, r = 0.611 and p < 0.05; Pslco2 vs Pico2, r = 0.613 and p < 0.05; Pslco2 vs Pico2-Paco2 gradient, r = 0.648 and p < 0.05).

Conclusion: Pslco2 correlated best with Pico2 and arterial lactate concentration in patients with cardiac failure. Pslco2 and the Pslco2-Paco2 gradient may be useful as indexes of the severity of perfusion failure.

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