Mh. Weil et al., Sublingual capnometry: A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock, CRIT CARE M, 27(7), 1999, pp. 1225-1229
Objective: To investigate the feasibility and predictive value of sublingua
l Pco(2) (P(SL)co(2)) measurements as a noninvasive and early indicator of
systemic perfusion failure.
Design:A prospective, criterion study.
Setting: Emergency department and medical and surgical intensive care units
of an urban community medical center.
Participants and Patients: Five normal human volunteers and 46 patients wit
h acutely life-threatening illness or injuries. Interventions: Intra-arteri
al or automated cuff blood pressure and arterial blood lactate (LAC) were m
easured concurrently with P(SL)co(2).
Results: P(SL)co(2) in five healthy volunteers was 45.2 +/- 0.7 mm Hg (mean
+/- so). Twenty-six patients with physical signs of circulatory shock and
LAC >2.5 mmol/L had a P-SL co(2) of 81 +/- 24 mm Hg. This contrasted with p
atients admitted without clinical signs of shock and LAC of <2.5 mmol/L who
had a P(SL)co(2) of 53 +/- 8 mm Hg (p < .001), The initial P(SL)co(2) of 1
2 patients who died before recovery from shock was 93 +/- 27 mm Hg, and thi
s contrasted with 58 +/- 11 mm Hg (p < .001) in hospital survivors, Increas
es in P(SL)co(2) were correlated with increases in LAC (r(2) = .84; p < .00
1). When P(SL)co(2) exceeded a threshold of 70 mm Hg, its positive predicti
ve value for the presence of physical signs of circulatory shock was 1.00,
When it was <70 mm tig, it predicted survival with a predictive value of 0.
93,
Conclusion: P(SL)co(2) may serve as a technically simple and noninvasive cl
inical measurement for the diagnosis and estimation of the severity of circ
ulatory shock states.