Abstract:
OBJECTIVE:To study the course of gastric regional PCO2 (PrCO2) in patients with cardiogenic shock requiring intra-aortic balloon (IAB) counterpulsation and the prognostic value of PrCO2 in this patient population. DESIGN:A prospective, observational clinical study. SETTING:Medical intensive care unit in a university hospital. PATIENTS:Twenty-six consecutive patients with cardiogenic shock requiring mechanical support with an IAB counterpulsation undergoing mechanical ventilation INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULT:Hemodynamic variables, tonometric variables, arterial blood gases, and arterial lactate were assessed before insertion of IAB (baseline), and 1, 2, 3, 8, 16, 24, and 48 hrs thereafter. A subset of these patients (n = 14) were studied just before and 1, 8, 24, and 32 hrs after IAB removal; 12/26 patients (46.2%) died. Cardiac index increased from baseline to 1 hr after insertion of IAB (1.7 +/- 0.3 to 2.6 +/- 0.8 L/min/m2, p < .05). PrCO2 did not change between admission (47 +/- 13 torr [6.3 +/- 1.7 kPa]) and 8 hrs after placement of IAB but increased to 63 +/- 22 torr (8.4 +/- 2.9 kPa) at 16 hrs (p < .05) without any further alteration until 48 hrs. CO2 gap showed a similar pattern with 15 +/- 11 torr (2.0 +/- 1.5 kPa) at baseline and an increase to 28 +/- 22 torr (3.7 +/- 2.9 kPa) 16 hrs later. PrCO2 and CO2 gap remained at high levels (59 +/- 11 torr [7.7 +/- 1.5 kPa] and 22 +/- 10 torr [2.9 +/- 1.3 kPa], respectively), before IAB removal without further improvement or deterioration thereafter. PrCO2 values showed no difference between survivors and nonsurvivors at any time point. CONCLUSION:Patients with cardiogenic shock developed high PrCO2 within the first 24 hrs, which reflects gastric mucosal ischemia. Persistently high levels of PrCO2 were indicative for prolonged hypoperfusion of the gut. Gastric tonometry failed to discriminate between survivors and nonsurvivors.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Janssens U,Graf J,Koch KC,vom Dahl J,Hanrath Pdoi
10.1097/00003246-200010000-00013subject
Has Abstractpub_date
2000-10-01 00:00:00pages
3449-55issue
10eissn
0090-3493issn
1530-0293journal_volume
28pub_type
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journal_title:Critical care medicine
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2008-07-01 00:00:00
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doi:10.1097/00003246-200103000-00005
更新日期:2001-03-01 00:00:00
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更新日期:1988-04-01 00:00:00
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更新日期:1993-01-01 00:00:00
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doi:10.1097/00003246-200007000-00057
更新日期:2000-07-01 00:00:00
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doi:10.1097/01.ccm.0000178175.54354.ea
更新日期:2005-09-01 00:00:00
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pub_type: 杂志文章
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更新日期:1989-09-01 00:00:00
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更新日期:2005-11-01 00:00:00
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更新日期:2005-11-01 00:00:00
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更新日期:1989-12-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2001-12-01 00:00:00
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更新日期:1991-07-01 00:00:00
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更新日期:1993-12-01 00:00:00
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更新日期:2016-12-01 00:00:00
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更新日期:2000-11-01 00:00:00
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更新日期:2004-04-01 00:00:00
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更新日期:2003-11-01 00:00:00
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