Buccal capnometry for quantitating the severity of hemorrhagic shock.

We have recently demonstrated that measurement of buccal mucosal PCO2 (PBUCO2) is a reliable alternative to sublingual mucosal PCO2 for measuring the severity of hemorrhagic shock. We hypothesized that measurement of PBUCO2 would serve as a continuous and a more sensitive and specific measurement for predicting survival during hemorrhagic shock than conventional measurements and thereby better guide initial management. Four groups of five pentobarbital anesthetized Sprague-Dawley rats were randomly assigned to be bled over 30 min in amounts estimated to be 25%, 30%, 35%, or 40% of total blood volume. With an optical PCO2 sensor applied noninvasively to the mucosa of the left inner cheek, PBUCO2 was continuously measured together with arterial pressure, end-tidal PCO2, and intermittent measurement of cardiac output, arterial blood lactate, and base deficit. Surviving animals had free access to water and food but no other treatment during the 72-h interval after recovery from anesthesia. After an estimated 40% blood loss, all animals died within 1 h. In the remaining animals, arterial pressure, end-tidal carbon dioxide, cardiac index, blood lactate, and base deficit each failed to discriminate among animals with 35%, 30%, and 25% acute blood losses. This contrasted with PBUCO2, which discriminated between the magnitude of massive blood loss and untreated survival. Buccal mucosal PCO2 was predictive of outcome after rapid bleeding when compared with arterial pressure, end-tidal carbon dioxide, cardiac index, arterial blood lactate, and base deficit. This measurement is therefore likely to serve as a useful guide for the immediate management of hemorrhagic shock.

Buccal capnometry to guide management of massive blood loss.

In both clinical and experimental settings, tissue P(CO2) measured in the oral mucosa is a practical and reliable measurement of the severity of hypoperfusion. We hypothesized that a threshold level of buccal tissue P(CO2) (P(CO2) BU)) would prognosticate the effects of volume repletion on survival. Twenty pentobarbital-anesthetized Sprague-Dawley male breeder rats, each weighing approximately 0.5 kg, were randomly assigned to one of four groups. Animals were bled over an interval of 30 min in amounts estimated to be 25, 30, 35, or 40% of total blood volume. One-half hour after the completion of bleeding, each animal received an infusion of Ringer lactate solution over the ensuing 30 min in amounts equivalent to two times the volume of blood loss. P(CO2) BU) was measured continuously with an optical P(CO2) sensor applied noninvasively to the mucosa of the left cheek. Arterial pressure and end-tidal CO2 were measured over the same interval. Neurological deficit and 72-h survival were recorded. Aortic pressures were restored to near baseline values for each of the four groups after fluid resuscitation. This contrasted with the improvement of P(CO2) BU), which differentiated between animals with short and long durations of postintervention survival. After electrolyte fluid resuscitation in rats subjected to rapid bleeding, noninvasive measurement of P(CO2) BU) was predictive of outcomes. Neither noninvasive end-tidal P(CO2) nor invasive aortic pressure measurements achieved such discrimination. Accordingly, P(CO2) BU) fulfills the criterion of a noninvasive and reliable measurement to guide fluid management of hemorrhagic shock.