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BGA MONITORING

This article explores the use of BGA monitoring to evaluate the effects of therapy on occult hypoperfusion. It discusses the importance of monitoring markers such as ScvO2, lactate, and delta PCO2. The article also highlights the relationship between lactate concentration and liver and kidney metabolism production. Additionally, it discusses the significance of early lactate clearance in improving outcomes.

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BGA MONITORING

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  1. BGA MONITORING

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

  3. 140 12 120 10 100 8 80 6 VO2 ml/min 60 Lactate mmol/L 4 40 2 20 0 0 0 50 100 150 200 250 300 350 400 The Supply-Dependency OER DO2 ml/min/m2

  4. SaO2 CO ScvO2 Hb VO2

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

  6. 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

  7. “instantaneous” LACTATE CONCENTRATION vs LIVER & KIDNEY METABOLISM PRODUCTION vs

  8. x 100 EARLY LACTATE CLEARANCE IS ASSOCIATED WITH IMPROVED OUTCOME Lactate start - Lactate 6 H Lactate start NGUYEN HB, RIVERS EP (2004) CCM 32;8:1637-42

  9. Circulation 1989;80:684-692

  10. CO2 AS MONITOR OF PERFUSION

  11. PCO2 The CO2 lung presentation & low flow A V O2 demand DO2 VO2 ATP AMP + H+ Lact- + H+ H+ + HCO3-

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

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

  14. 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”

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