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Detection of perfusion failure during open heart surgery with sublingual PCO2

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Background

Gastric tonometry has been used to detect intramucosal acidosis. However, there remains controversies about the methodology and interpretation of the results. In recent years, sublingual PCO2 (PSLCO2) has been introduced as a noninvasive method to detect perfusion failure. Yet, there has not been enough evidence to prove that the PSLCO2 is clinically of use.

Purposes

To define the efficacy of PSLCO2.

Methods

We investigated 6 patients who underwent open-heart surgery. PSLCO2 were recorded continuously with a PCO2 sensor based on an ion-sensitive field effect transistor (ISFET, NIHON KOHDEN). Arterial lactate was also measured.

Result

A substantial increase of PSLCO2 came into our notice from 377 mmHg, at the time of induction to 5712 mmHg, during the cardiopulmonary bypass (CPB).Gradual decrease of PSLCO2 after the aorta declamping was observed down to 485 mmHg, 6 h after the operation. Significant increase in PSLCO2 indicates that oxidization is not fairly sustained to the tissue during CPB despite enough pump flow. The increase in blood lactate concentration was followed parallel to PSLCO2 while CPB was performed.

Conclusion

PSLCO2 is an attractive parameter to be served for the swift detection of perfusion failure during open-heart surgery.

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Inoue, H., Sato, I., Hitosugi, N. et al. Detection of perfusion failure during open heart surgery with sublingual PCO2. Crit Care 4, P157 (2000). https://doi.org/10.1186/cc877

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Keywords

  • Lactate
  • Cardiopulmonary Bypass
  • Blood Lactate
  • Lactate Concentration
  • Heart Surgery