Tonometry

Splanchnic hypoperfusion

Jouko Laurila, M.D. and Tero Ala-Kokko, M.D.
Department of Anesthesiology, ICU
Oulu University Hospital,
Oulu, FIN 90220, FINLAND

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Case history

The patient is a 29 year old male, with a severe pancreatitis caused by alcohol abuse. On admission to the ICU the pulmonary artery catheter was inserted and he was connected to ventilator. In the beginning the patient did not need any vasoactive drugs, but the tissue oxygenation was managed by adequate fluid therapy.

Case report

On the second intensive care day continuous monitoring of gastric mucosal PCO2 (PICO2 = PgCO2) with TONOCAP monitor was started. This disclosed evidence of increased PgCO2, but the laboratory findings did not show any systemic acidosis nor increased arterial lactate levels. Due to the evident hypoperfusion of the splanchnic region a treatment trial with dopexamine was started. The goals were to keep the PgCO2 below 8 kPa or the PCO2 gap (PgCO2 – EtCO2) below 2 kPa.

The trend picture shows how the gastric PgCO2 reacts fast and favorably to the dopexamine administration and the changes in its dose.

The continuous monitoring of PgCO2 of this patient with Tonocap monitor helped in the optimization of care and in drug administration and titration.

Last updated: 1 September 2000
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