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Groeneveld, A. B. J.

doi:10.1186/cc694

Cited by 12 publications

(2 citation statements)

References 16 publications

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“…While the pathogenesis of sepsis and septic shock is well recognized and it is accepted that the data provided by mucosal CO 2 have unquestionable validity as a reflection of the severity of the shock, the search for new noninvasive and easy to perform monitoring strategies is constant in this field [ 19 ]. This is currently raising more expectation of the probing on the most proximal segments of gastrointestinal tract, especially the sublingual capnography [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Bladder Mucosal CO₂Compared with Gastric Mucosal CO₂as a Marker for Low Perfusion States in Septic Shock

Seller-Pérez

Herrera-Gutiérrez

Aragón-González

et al. 2012

The Scientific World Journal

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Recent reports indicate the possible role of bladder CO2 as a marker of low perfusion states. To test this hypothesis, shock was induced in six beagle dogs with 1 mg/kg of E. coli lipopolysaccharide, gastric CO2 (CO2-G) was measured with a continuous monitor, and a pulmonary catheter was inserted in the bladder to measure CO2 (CO2-B). Levels of CO2-B were found to be lower than those of CO2-G, with a mean difference of 36.8 mmHg (P < 0.001), and correlation between both measurements was poor (r 2 = 0.16). Even when the correlation between CO2-G and ΔCO2-G was narrow (r 2 = 0.86), this was not the case for the relationship between CO2-B and ΔCO2-B (r 2 = 0.29). Finally, the correlation between CO2-G and base deficit was good (r 2 = 0.45), which was not the case with the CO2-B correlation (r 2 = 0.03). In our experience, bladder CO2 does not correlate to hemodynamic parameters and does not substitute gastric CO2 for detection of low perfusion states.

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Section: Discussionmentioning

confidence: 99%

Bladder Mucosal CO₂Compared with Gastric Mucosal CO₂as a Marker for Low Perfusion States in Septic Shock

Seller-Pérez

Herrera-Gutiérrez

Aragón-González

et al. 2012

The Scientific World Journal

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“…6. Hepatosplanchnic-related perfusion parameters: a) gastric tonometry calculating the gastric-to-arterial pCO 2 gradient (pCO 2 gap) with a upper normal limit of 8 mmHg (Tonocap, Datex-Ohmeda Division, Helsinki, Finland) [ 22 ]; and b) plasma disappearance rate of indocyanine green (ICG-PDR) as a dynamic test for the assessment of liver function and global hepatosplanchnic blood flow [ 23 ]. The ICG-PDR was assessed with a noninvasive liver function monitoring system (LiMon, Pulsion Medical Systems, Munich, Germany).…”

Section: Methodsmentioning

confidence: 99%

Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study

et al. 2012

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BackgroundRecent clinical studies have confirmed the strong prognostic value of persistent hyperlactatemia and delayed lactate clearance in septic shock. Several potential hypoxic and nonhypoxic mechanisms have been associated with persistent hyperlactatemia, but the relative contribution of these factors has not been specifically addressed in comprehensive clinical physiological studies. Our goal was to determine potential hemodynamic and perfusion-related parameters associated with 6-hour lactate clearance in a cohort of hyperdynamic, hyperlactatemic, septic shock patients.MethodsWe conducted an acute clinical physiological pilot study that included 15 hyperdynamic, septic shock patients undergoing aggressive early resuscitation. Several hemodynamic and perfusion-related parameters were measured immediately after preload optimization and 6 hours thereafter, with 6-hour lactate clearance as the main outcome criterion. Evaluated parameters included cardiac index, mixed venous oxygen saturation, capillary refill time and central-to-peripheral temperature difference, thenar tissue oxygen saturation (StO2) and its recovery slope after a vascular occlusion test, sublingual microcirculatory assessment, gastric tonometry (pCO2 gap), and plasma disappearance rate of indocyanine green (ICG-PDR). Statistical analysis included Wilcoxon and Mann–Whitney tests.ResultsFive patients presented a 6-hour lactate clearance <10%. Compared with 10 patients with a 6-hour lactate clearance ≥10%, they presented a worse hepatosplanchnic perfusion as represented by significantly more severe derangements of ICG-PDR (9.7 (8–19) vs. 19.6 (9–32)%/min, p < 0.05) and pCO2 gap (33 (9.1-62) vs. 7.7 (3–58) mmHg, p < 0.05) at 6 hours. No other systemic, hemodynamic, metabolic, peripheral, or microcirculatory parameters differentiated these subgroups. We also found a significant correlation between ICG-PDR and pCO2 gap (p = 0.02).ConclusionsImpaired 6-hour lactate clearance could be associated with hepatosplanchnic hypoperfusion in some hyperdynamic septic shock patients. Improvement of systemic, metabolic, and peripheral perfusion parameters does not rule out the persistence of hepatosplanchnic hypoperfusion in this setting. Severe microcirculatory abnormalities can be detected in hyperdynamic septic shock patients, but their role on lactate clearance is unclear. ICG-PDR may be a useful tool to evaluate hepatosplanchnic perfusion in septic shock patients with persistent hyperlactatemia.Trial registrationClinicalTrials.gov Identifier: NCT01271153

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Effect of thoracic epidural anaesthesia on splanchnic blood flow

Richards

Kabir

McNaught

et al. 2012

British Journal of Surgery

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Cited by 12 publications

References 16 publications

Bladder Mucosal CO₂Compared with Gastric Mucosal CO₂as a Marker for Low Perfusion States in Septic Shock

Bladder Mucosal CO₂Compared with Gastric Mucosal CO₂as a Marker for Low Perfusion States in Septic Shock

Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study

Effect of thoracic epidural anaesthesia on splanchnic blood flow

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Untitled

Cited by 12 publications

References 16 publications

Bladder Mucosal CO2Compared with Gastric Mucosal CO2as a Marker for Low Perfusion States in Septic Shock

Bladder Mucosal CO2Compared with Gastric Mucosal CO2as a Marker for Low Perfusion States in Septic Shock

Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study

Effect of thoracic epidural anaesthesia on splanchnic blood flow

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Bladder Mucosal CO₂Compared with Gastric Mucosal CO₂as a Marker for Low Perfusion States in Septic Shock

Bladder Mucosal CO₂Compared with Gastric Mucosal CO₂as a Marker for Low Perfusion States in Septic Shock