Effects of Fluid Challenge on Gastric Mucosal PCO2 in Septic Patients

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2004 Jan 15

PMID 14722633

Citations 11

Authors

Eliezer Silva

Daniel De Backer

Jacques Creteur

Jean-Louis Vincent

Affiliations

Soon will be listed here.

Abstract

Objective: To determine the effects of fluid challenge on systemic hemodynamic variables and gastric intramucosal partial pressure of carbon dioxide (PCO(2)) in septic patients.

Design: Short-term interventional study.

Setting: Medical-surgical intensive care unit in a university hospital.

Patients: Twenty-four adult patients with severe sepsis or septic shock requiring volume replacement. All patients were studied within 24 h of onset of severe sepsis or septic shock.

Interventions: Five hundred milliliters of a 6% hydroxyethyl starch (HES) solution were administered in 30 min.

Measurements And Results: Complete hemodynamic data, blood samples, and gastric mucosal PCO(2) (automatic gas capnometry) determinations were obtained at baseline and 15 min after the end of fluid infusion. After fluid challenge, cardiac index (CI) increased from 3.8 (range 2.9-4.2) to 4.2 (range 3.1-4.9) l/min m(-2) ( p<0.05). The PCO(2) gap decreased from 9.8 (range 6.9-26.0) to 8.5 (range 6.6-17.4) mm Hg ( p<0.05), but important individual variations were observed. We failed to observe significant relationships between changes in CI and in PCO(2) gap, or between indices of preload (pulmonary artery occluded pressure, right atrial pressure, and pulse pressure variations) and changes in PCO(2) gap. In addition, changes in PCO(2) gap and in (v-a) CO(2) were not related; however, changes in PCO(2) gap were related to baseline PCO(2) gap ( p=0.003), PEEP ( p=0.02), and cumulative doses of vasopressors ( p=0.02).

Conclusions: The effects of fluid challenge on gastric mucosal PCO(2) are variable and related to baseline PCO(2) gap rather than to systemic variables. In general, rapid volume infusion decreases PCO(2) gap, but this effect is more pronounced in patients with presumably impaired mucosal perfusion.

Citing Articles

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References

Haupt M, Gilbert E, Carlson R . Fluid loading increases oxygen consumption in septic patients with lactic acidosis. Am Rev Respir Dis. 1985; 131(6):912-6. DOI: 10.1164/arrd.1985.131.6.912. View

Barquist E, Kirton O, Windsor J, Lynn M, Herman M, Civetta J . The impact of antioxidant and splanchnic-directed therapy on persistent uncorrected gastric mucosal pH in the critically injured trauma patient. J Trauma. 1998; 44(2):355-60. DOI: 10.1097/00005373-199802000-00022. View

Kiefer P, Nunes S, Kosonen P, Takala J . Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury. Intensive Care Med. 2000; 26(4):376-83. DOI: 10.1007/s001340051170. View

Maynard N, Bihari D, Beale R, Smithies M, Baldock G, Mason R . Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA. 1993; 270(10):1203-10. View

Tamion F, Richard V, Sauger F, Menard J, Girault C, Richard J . Gastric mucosal acidosis and cytokine release in patients with septic shock. Crit Care Med. 2003; 31(8):2137-43. DOI: 10.1097/01.CCM.0000079600.49048.28. View

Mythen M, Webb A . Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995; 130(4):423-9. DOI: 10.1001/archsurg.1995.01430040085019. View

Levy M, Fink M, Marshall J, Abraham E, Angus D, Cook D . 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003; 31(4):1250-6. DOI: 10.1097/01.CCM.0000050454.01978.3B. View

Heard S . Gastric tonometry: the hemodynamic monitor of choice (Pro). Chest. 2003; 123(5 Suppl):469S-74S. DOI: 10.1378/chest.123.5_suppl.469s. View

Boldt J, Heesen M, Muller M, Pabsdorf M, Hempelmann G . The effects of albumin versus hydroxyethyl starch solution on cardiorespiratory and circulatory variables in critically ill patients. Anesth Analg. 1996; 83(2):254-61. DOI: 10.1097/00000539-199608000-00010. View

10.

Creteur J, De Backer D, Vincent J . Monitoring gastric mucosal carbon dioxide pressure using gas tonometry: in vitro and in vivo validation studies. Anesthesiology. 1997; 87(3):504-10. DOI: 10.1097/00000542-199709000-00008. View

11.

Sumpelmann R, Schurholz T, Marx G, Zander R . Protective effects of plasma replacement fluids on erythrocytes exposed to mechanical stress. Anaesthesia. 2000; 55(10):976-9. DOI: 10.1046/j.1365-2044.2000.01531.x. View

12.

Asfar P, Kerkeni N, Labadie F, Gouello J, Brenet O, Alquier P . Assessment of hemodynamic and gastric mucosal acidosis with modified fluid versus 6% hydroxyethyl starch: a prospective, randomized study. Intensive Care Med. 2000; 26(9):1282-7. DOI: 10.1007/s001340000606. View

13.

Oud L, Haupt M . Persistent gastric intramucosal ischemia in patients with sepsis following resuscitation from shock. Chest. 1999; 115(5):1390-6. DOI: 10.1378/chest.115.5.1390. View

14.

Castro V, Astiz M, Rackow E . Effect of crystalloid and colloid solutions on blood rheology in sepsis. Shock. 1997; 8(2):104-7. DOI: 10.1097/00024382-199708000-00007. View

15.

De Backer D, Creteur J, Noordally O, Smail N, Gulbis B, Vincent J . Does hepato-splanchnic VO2/DO2 dependency exist in critically ill septic patients?. Am J Respir Crit Care Med. 1998; 157(4 Pt 1):1219-25. DOI: 10.1164/ajrccm.157.4.9705075. View

16.

Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R . Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet. 2002; 360(9328):219-23. DOI: 10.1016/S0140-6736(02)09459-X. View

17.

Hamilton-Davies C, Mythen M, Salmon J, Jacobson D, Shukla A, Webb A . Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intensive Care Med. 1997; 23(3):276-81. DOI: 10.1007/s001340050328. View

18.

Friedman G, Berlot G, KAHN R, Vincent J . Combined measurements of blood lactate concentrations and gastric intramucosal pH in patients with severe sepsis. Crit Care Med. 1995; 23(7):1184-93. DOI: 10.1097/00003246-199507000-00006. View

19.

. Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med. 1999; 27(3):639-60. DOI: 10.1097/00003246-199903000-00049. View

20.

Levy B, Gawalkiewicz P, Vallet B, Briancon S, Nace L, Bollaert P . Gastric capnometry with air-automated tonometry predicts outcome in critically ill patients. Crit Care Med. 2003; 31(2):474-80. DOI: 10.1097/01.CCM.0000050445.48656.28. View