Sublingual capnometry tracks microcirculatory changes in septic patients

Objective: To test the hypothesis that microcirculatory blood flow is the main determinant of sublingual carbon dioxide pressure in patients with septic shock. Design: Prospective, open-label study Setting: A 31-bed medico-surgical department of intensive care. Patients: Eighteen consecutive mechanically ventilated patients with septic shock. Interventions: A 5 mu g/kg center dot min dobutamine infusion was used to increase blood flow. Methods: Sublingual carbon dioxide pressure was monitored using a microelectrode sensor, and sublingual microcirculation was assessed using orthogonal polarization spectral imaging. The sublingual carbon dioxide pressure gap was calculated as the difference between sublingual and arterial carbon dioxide pressures. In each patient, a nasogastric tonometry catheter was inserted for gastric mucosal carbon dioxide pressure measurement. The gastric carbon dioxide pressure gap was calculated as the difference between gastric mucosal and arterial carbon dioxide pressures. Measurements and results: Dobutamine infusion was associated with increases cardiac index and mixed venous blood oxygen saturation. Dobutamine infusion resulted in decreases in sublingual carbon dioxide pressure gap from 40 +/- 15 to 17 +/- 8 mmHg (p < 0.01). There was a significant correlation between sublingual and gastric mucosal carbon dioxide pressures (r(2) = 0.61, p < 0.05). At baseline, sublingual carbon dioxide pressure gap correlated with the proportion of well-perfused capillaries (r(2) = 0.80). The decrease in sublingual carbon dioxide pressure gap paralleled the increase in the proportion of well-perfused capillaries in each patient. Conclusions: Regional microcirculatory blood flow is the main determinant of sublingual carbon dioxide pressure. Sublingual capnometry could represent a simple, non-invasive method to monitor these microcirculatory alterations in septic patients.