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Influence of alveolar ventilation changes on calculated gastric intramucosal pH and gastric-arterial PCO2 difference.

Abstract：

OBJECTIVE:To evaluate the influence of changes in alveolar ventilation on the following tonometry-derived variables: gastric intramucosal CO2 tension (PtCO2), gastric arterial CO2 tension difference (PgapCO2), gastric intramucosal pH (pHi) and arterial pH-pHi difference (pHgap). DESIGN:Clinical prospective study. SETTING:A medical intensive care unit in a university hospital. PATIENTS:Ten critically ill, mechanically ventilated patients requiring hemodynamic monitoring with pulmonary artery catheter. INTERVENTIONS:Gastric tonometer placement. A progressive increase in tidal volume (V(T)) from 7 to 10 ml/ kg followed by an abrupt return to baseline V(T) level. MEASUREMENTS AND MAIN RESULTS:Tonometer saline PtCO2 and hemodynamic data were collected hourly at various V(T) levels: H0 and H0' (baseline V(T) = 7 ml/kg), H1 (V(T) = 8 ml/kg), H2 (V(T) = 9 ml/kg), H3 (V(T) = 10 ml/kg), H4 (baseline V(T)). During the "hyperventilation phase" (H0-H3), pHi (p<0.01) and pHgap (p<0.05) increased but PgapCO2 remained unchanged. Cardiac output (CO) was not affected by ventilatory change. During the "hypoventilation phase" (H3-H4), pHi fell from 7.27+/-0.11 to 7.23+/-0.09 (p<0.01) and PgapCO2 decreased from 16+/-5 mm Hg to 13+/-4 mm Hg (p<0.05). V(T) reduction was associated with a significant cardiac output elevation (p<0.05). CONCLUSIONS:PaCO2 and PtCO2 are similarly influenced by the changes in alveolar ventilation. Unlike pHi, the PgapCO2 is not affected by ventilation variations unless CO changes are associated.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Bernardin G,Lucas P,Hyvernat H,Deloffre P,Mattéi M

doi

10.1007/s001340050834

keywords:

subject

Has Abstract

pub_date

1999-03-01 00:00:00

pages

269-73

issue

3

eissn

0342-4642

issn

1432-1238

journal_volume

25

pub_type

临床试验,杂志文章

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