Monitoring gastrointestinal intraluminal PCO2: problems with airflow methods

Assessment of a new prototype hydrogel CO 2 sensor; comparison with air tonometry

OBJECTIVE

Gastrointestinal ischemia is always accompanied by an increased luminal CO(2). Currently, air tonometry is used to measure luminal CO(2). To improve the response time a new sensor was developed, enabling continuous CO(2) measurement. It consists of a pH-sensitive hydrogel which swells and shrinks in response to luminal CO(2), which is measured by the pressure sensor. We evaluated the potential clinical value of the sensor during an in vitro and in vivo study.

METHODS

The response time to immediate, and stepwise change in pCO(2) was determined between 5 and 15 kPa, as well as temperature sensitivity between 25 and 40 degrees C at two pCO(2) levels. Three sensors were compared to air tonometry (Tonocap) in healthy volunteers using a stepwise incremental exercise test, followed by a period of hyperventilation and an artificial CO(2)-peak.

RESULTS

The in vitro response time to CO(2) increase and decrease was mean 5.9 and 6.6 min. The bias, precision and reproducibility were +5%, 3% and 2%, resp. Increase of 1 degrees C at constant pCO(2) decreased sensor signal by 8%. In vivo tests: The relation with the Tonocap was poor during the exercise test. The response time of the sensor was 3 min during hyperventilation and the CO(2) peak.

CONCLUSION

The hydrogel carbon dioxide sensor enabled fast and accurate pCO(2) measurement in a controlled environment but is very temperature dependent. The current prototype hydrogel sensor is still too unstable for clinical use, and should therefore be improved.

Airflow-based PCO2 monitoring delivers O2 and removes CO2 from the monitored environment

Previous investigation has suggested that the use of airflow-based gastrointestinal intraluminal PCO2 (GI PiCO2) monitoring systems may affect the local tissue microenvironment, making it not representative of the organ system as a whole. Therefore, we investigated the effects of using an airflow-based PCO2 monitoring system in a sealed environment. A 250-mL Erlenmeyer flask was filled with 10% CO2/90% N2 and was sealed with probes in place. Using a fiber-optic (Neotrend, Diametrix Medical, St. Paul, MN) system, the PCO2 and PO2 were continuously monitored with and without the airflow-based (Tonocap, Tonometrics, Datex-Ingstrom, Helsinki, Finland) system operating. PCO2 and PO2 remained constant when the airflow-based system was not in operation. PCO2 decreased 25.3 mmHg and PO2 increased 30 mmHg from a starting value of 0 mmHg when the airflow-based system was in operation for 12 h. The use of airflow-based methods for determining GI PiCO2 may influence the values obtained. Nonsample removing techniques such as fiber-optic methods for monitoring GI PiCO2 are preferable because they neither deliver O2 to nor remove CO2 from the local microenvironment.

Enalaprilat improves systemic cardiovascular parameters and mesenteric blood flow during hypotensive resuscitation from hemorrhagic shock in dogs

Resuscitative interventions that improve mesenteric perfusion without causing instability in systemic arterial pressures may be helpful for improving trauma patient outcomes. Blocking angiotensin II formation with enalaprilat may be such an intervention. Two questions were addressed in this two-part study investigating resuscitation from hemorrhagic shock in dogs: Can systemic arterial pressures be maintained while administering a constant rate infusion of enalaprilat during resuscitation, and can enalaprilat improve cardiovascular status during resuscitation? Animals were hemorrhaged to a mean arterial pressure (MAP) of 40 to 45 mmHg for 30 min and then 30 to 35 mmHg for 30 min. Group I (n = 5) was resuscitated to a MAP 60 to 65 mmHg with enalaprilat (0.02 mg/kg/h). Group II was resuscitated to a MAP 40 to 45 mmHg with (n = 5) or without (n = 5) enalaprilat. Resuscitation in both groups consisted of intermittent intravenous lactated Ringer's solution (60 mL/kg/h) to reach and maintain the target MAPs. Systemic arterial pressures were unaffected by enalaprilat during resuscitation in Group I, allowing us to proceed to the second study. During severely hypotensive resuscitation (Group II), systemic arterial pressures were also stable and enalaprilat administration was associated with increases (P < or = 0.02) in cardiac index (+1.2 L/min/m2), stroke volume index (SVI) (+14.5 mL/m2), superior mesenteric artery flow (+80 mL/min), stroke work (+561 mmHg/mL/m2), and left ventricular power output (+55.7 mmHg/L/min/m2). Corresponding increases were not observed in controls. We conclude that administration of a constant rate infusion of enalaprilat during resuscitation can be accomplished without causing a hypotensive crisis. Since enalaprilat significantly improved cardiovascular status including mesenteric perfusion even during intentional hypotension, it has potential value for improving the treatment of trauma patients.