実験的発作性頻拍時の胃粘膜二酸化炭素分圧の連続モニタ

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  • Continuous Monitoring Of Gastric Intramucosal PCO2 During Experimental Paroxysmal Tachycardia

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Gastrointestinal mucosal ischemia is one of the earliest manifestations of impaired core tissue perfusion in the critically ill, and its presence is highly predictive for the development of life-threatening complications. The measurement of gastric intramucosal PCO2 (PiCO2) is a sensitive indicator of the adequacy of gastrointestinal oxygenation. We compared PiCO2 variables using conventional saline tonometry (PiCO2-TONO) and an ion-sensitive field effect transistor (ISFET) sensor (PiCO2-ISFET) in an experimental beagle model (n=9) of paroxysmal tachycardia induced by rapid ventricular pacing at 390 beats/min for 180min. With rapid pacing, gastric PiCO2-TONO increased significantly from the baseline of 56±5 (mean±SD) to 72±7 at 90min and 71±7mmHg at 180min. Time-coincident gastric PiCO2-ISFET also increased significantly from 62±5 to 84±8 and 79±9mmHg. Sixty minutes after the cessation of rapid pacing, both PiCO2-TONO and PiCO2-ISFET dropped to near baseline levels. PiCO2-ISFET values were significantly higher than those of PiCO2-TONO, although the correlation between the two was r2=0.53 (p<0.01). Bland-Altman analysis revealed a bias of 8.5mmHg and a precision of 7.7mmHg. PiCO2, measured by saline tonometry, may underestimate actual PiCO2. As contrasted with PiCO2 by saline tonometry, which is a manual, discontinuous procedure, PiCO2 using the ISFET sensor provides automatic continuous numerical display of real-time data, and may be of great advantage in the diagnosis and evaluation of critically ill patients.

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