Am. J. Respir. Crit. Care Med., Volume 157, Number 6, June 1998, 1838-1843

Sublingual Capnometry for Diagnosis and Quantitation of Circulatory Shock

YOSHIHIDE NAKAGAWA, MAX HARRY WEIL, WANCHUN TANG, SHIJIE SUN, HITOSHI YAMAGUCHI, XIAOHUA JIN, and JOE BISERA

Institute of Critical Care Medicine, Palm Springs, California; and The University of Southern California School of Medicine, Los Angeles, California

We investigated sublingual tissue PCO₂ during hemorrhagic and septic shock. Hemorrhagic shock was induced in 10 rats. Sublingual PCO₂ increased from 45 to 125 mm Hg and arterial pressure declined from 138 to 49 mm Hg, end-tidal PCO₂ decreased from 35 to 13 mm Hg, and cardiac index fell from 290 to 77 ml/min/kg. Arterial blood lactate increased from 0.9 to 15.8 mmol/L. Gastric PCO₂ was measured in five animals and it increased from 46 to 87 mm Hg. No significant changes were observed in eight "sham" bled animals including the five animals in which gastric PCO₂ was measured. Highly significant linear correlations (p < 0.001) between sublingual PCO₂ and gastric PCO₂ (r = 0.71), cardiac index (r = 0.74), and arterial lactate (r = 0.59) were documented. We subsequently investigated sublingual PCO₂ in five animals in which sepsis was induced by intravenous infusion of live Staphylococcus aureus. Like hemorrhagic shock, highly significant linear correlations were observed between end-tidal PCO₂ and cardiac index and between sublingual PCO₂ and arterial blood lactate. Sublingual PCO₂ promises to serve as a technically simple, noninvasive, and rapid response quantitator of severity of circulatory shock states.

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