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.