U. Janssens et al., Gastric tonometry in patients with cardiogenic shock and intra-aortic balloon counterpulsation, CRIT CARE M, 28(10), 2000, pp. 3449-3455
Objective: To study the course of gastric regional PCO2 (PrCO2) in patients
with cardiogenic shock requiring intra-aortic balloon (IAB) counterpulsati
on 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 shack requiring
mechanical support with an IAB counterpulsation undergoing mechanical venti
lation
Interventions: None.
Measurements and Main Result. Hemodynamic variables, tonometric variables,
arterial blood gases, and arterial lactate were assessed before insertion o
f IAB (baseline), and 1, 2, 3, 8, 16, 24, and 48 hrs thereafter. A subset o
f 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 fr
om baseline to 1 hr after insertion of IAB (1.7 +/- 0.3 to 2.6 +/- 0.8 L/mi
n/m(2), 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 +/- 2
2 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 +/- II 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 l
evels of PrCO2 were indicative for prolonged hypoperfusion of the gut Gastr
ic tonometry failed to discriminate between survivors and nonsurvivors.