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Am. J. Respir. Crit. Care Med., Volume 160, Number 5, November 1999, 1555-1561

Gastric Mucosal pH and Blood Flow during Weaning from Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease

NICOLAS BOCQUILLON, DANIEL MATHIEU, RÉMI NEVIERE, NATHALIE LEFEBVRE, XAVIER MARECHAL, and FRANCIS WATTEL

Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier et Universitaire de Lille, Lille, France

To determine if gastric intramucosal pH changes during weaning from mechanical ventilation are related to gastric mucosal blood flow modifications, we studied 16 ventilator-supported patients with chronic obstructive pulmonary disease (COPD) who tolerated a 2-h trial of spontaneous breathing with pressure support ventilation and were successfully extubated and 11 patients with COPD who failed such a trial. Gastric mucosal perfusion was assessed using gastric intramucosal pH (pHi) by tonometry and laser-Doppler flowmetry. During the weaning attempt, the failure weaning group developed a rapid, shallow breathing pattern with acute respiratory acidosis. The pHi was lower and gastric intramucosal PCO2 (PCO2im) was higher in the failure weaning group than in the successful weaning group (p < 0.05). No change in gastric intramucosal-arterial PCO2 difference was observed and a linear correlation was found between arterial PCO2 and PCO2im (r2 = 0.70; p < 0.001). Cardiac index increased in the failure group (p < 0.05) and remained stable in the success group whereas gastric mucosal blood flow decreased in the failure group (H120 min: -22 ± 11% from baseline; p < 0.05) and increased in the success group (H120 min: 85 ± 27% from baseline; p < 0.05). We conclude that gastric intramucosal pH changes during a 2-h weaning trial are mainly due to arterial PCO2 variations. Nevertheless, gastric mucosal blood flow changes do occur and differ according to the weaning success or failure. Bocquillon N, Mathieu D, Neviere R, Lefebvre N, Marechal X, Wattel F. Gastric mucosal pH and blood flow during weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease.




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