1. BGA MONITORING

2. in “occult” hypoperfusion
….a look from inside….
in “occult” hypoperfusion
ScvO2
LACTATE
DELTA PCO2
…helps to evaluate therapy effects…

3. The Supply-Dependency50
100
150
200
250
300
350
400 20 40 60 80
120
140 2 4 6 8 10 12
VO2 ml/min
Lactate mmol/L
OER
DO2 ml/min/m2

4. SaO2 CO
ScvO2 Hb
VO2

5. Ann Emerg Med. 2010;55:40-46

7. LACT & normal pH HYPERLACTATEMIA (PFK, shuttle, messenger)
LACT & low pH LACTIC ACIDOSIS
* Low Mitho Activity
* Low ATP/ADP
* High NADH/NAD
* Low pHi and pHo

8. “instantaneous” LACTATE CONCENTRATIONvs
LIVER & KIDNEY METABOLISM
PRODUCTION vs

11. EARLY LACTATE CLEARANCE IS ASSOCIATED WITH IMPROVED OUTCOME
Lactate start - Lactate 6 H
Lactate start
x 100
NGUYEN HB, RIVERS EP (2004) CCM 32;8:

13. Circulation 1989;80:

14. CO2 AS MONITOR OF PERFUSION

15. The CO2 lung presentation & low flowV
O2 demand
DO2
PCO2
VO2
ATP
AMP + H+
Lact- + H+
H+ + HCO3-

17. ∆ CO2 = 9.2
∆ CO2 = 5.3
OER = 36
OER = 33.5
FS 1993

19. = the future…? VO2 If low = O2 debt ÷ ScvO2 DO2 O2 Demand
+ low pH = lactic acidosis
VCO2
flow
÷ ΔvaPCO2
+ low pH = tissue acidosis
= the future…?
↓micro-flow ÷ ΔtaPCO2
Δva PCO2
: next ?????
ΔavO2 Content

20. KEY POINTS
Micro vs Macro
Serial Lactate better (fast vs slow clearance)
ScvO2 vs Delta PCO2 monitoring
Perspective: Lact/Pyr, pHi, Lactate Gaps……
Think about the “FULL PICTURE”