Gastric intramural pH in mechanically ventilated patients

Platinum Black/Gold Nanoparticles/Polyaniline Modified Electrochemical Microneedle Sensors for Continuous In Vivo Monitoring of pH Value

Continuous in vivo monitoring (CIVM) of pH value is essential for personalized medicine, as many diseases are closely related to acid-base imbalances. However, conventional pH meters are limited in their ability to perform CIVM due to excessive blood consumption, large device volume, frequent calibration, and inadequate real-time monitoring. There is thus an urgent need for a portable method for CIVM of pH value. To address this need, we propose a minimally invasive, continuous monitoring solution in the form of an implantable pH microneedle sensor (MNS) in this study. The MNS is based on the integration of an acupuncture needle (AN) and a Ag/AgCl reference electrode. We fabricate the sensor by electrochemically depositing platinum black and gold nanoparticles onto the AN and further modifying it with polyaniline to increase its sensitivity to hydrogen ions. The pH value is obtained by calculating the open circuit voltage between the modified AN and the reference electrode. The resulting MNS demonstrates excellent selectivity and a high nernstian response to pH (-57.4 mV per pH) over a broad range (pH = 4.0 to pH = 9.0). Both in vitro and in vivo experiments have verified the performance of the sensor, showcasing its potential for biomedical research and clinical practice. The MNS provides an alternative to conventional pH meters, offering a less invasive and more convenient way to perform CIVM of pH value. Moreover, this electrochemical implantable sensor based on AN and silver wires provides a simple and sensitive method for continuous in vivo detection of other biomarkers.

Microneedle pH Sensor: Direct, Label-Free, Real-Time Detection of Cerebrospinal Fluid and Bladder pH

Acid-base homeostasis (body pH) inside the body is precisely controlled by the kidneys and lungs and buffer systems, such that even a minor pH change could severely affect many organs. Blood and urine pH tests are common in day-to-day clinical trials and require little effort for diagnosis. There is always a great demand for in vivo testing to understand more about body metabolism and to provide effective diagnosis and therapy. In this article, we report the simple fabrication of microneedle-based direct, label-free, and real-time pH sensors. The reference and working electrodes were Ag/AgCl thick films and ZnO thin films on tungsten (W) microneedles, respectively. The morphological and structural characteristics of microneedles were carefully investigated through various analytical methods. The developed sensor exhibited a Nernstian response of -46 mV/pH. Different conditions were used to test the sensor to confirm their accuracy and stability, such as various buffer solutions, with respect to time, and we compared the reading with commercial pH electrodes. Besides that, the fabricated microneedle sensor ability is proven by in vivo testing in mouse cerebrospinal fluid (CSF) and bladders. The pH sensor procedure reported here is totally reversible, and results were reproducible after several rounds of testing.

Lack of agreement between tonometric and gastric juice partial carbon dioxide tension

STATEMENT OF FINDINGS: Our goal was to compare measurement of tonometered saline and gastric juice partial carbon dioxide tension (PCO2). In this prospective observational study, 112 pairs of measurements were simultaneously obtained under various hemodynamic conditions, in 15 critical care patients. Linear regression analysis showed a significant correlation between the two methods of measuring PCO2 (r(2) = 0.43; P < 0.0001). However, gastric juice PCO2 was systematically higher (mean difference 51 mmHg). The 95% limits of agreement were 315 mmHg and the dispersion increased as the values of PCO2 increased. Tonometric and gastric juice PCO2 cannot be used interchangeably. Gastric juice PCO2 measurement should be interpreted with caution.

Small bowel tonometry is more accurate than gastric tonometry in detecting gut ischemia

Gastric tonometer PCO2 measurement may help identify gut ischemia in critically ill patients but is frequently associated with large measurement errors. We tested the hypothesis that small bowel tonometer PCO2 measurement yields more accurate information. In 10 anesthetized, mechanically ventilated pigs subject to progressive hemorrhage, we measured gut oxygen delivery and consumption. We also measured tonometer PCO2 minus arterial PCO2 (DeltaPCO2) and calculated the corresponding intracellular pH from tonometers placed in the stomach and jejunum. We found that the correlation coefficient (r2) for biphasic gut oxygen delivery-DeltaPCO2 relationships was 0.29 +/- 0.52 for the gastric tonometer vs. 0.76 +/- 0.25 for the small bowel tonometer (P < 0.05). In addition, the critical gastric tonometer DeltaPCO2 was excessively high and variable (62.9 +/- 39.6) compared with the critical small bowel tonometer DeltaPCO2 (17.0 +/- 15.0, P < 0.01). Small bowel tonometer PCO2 was closely correlated with superior mesenteric vein PCO2 (r2 = 0.81, P < 0.001), whereas gastric tonometer PCO2 was not (r2 = -0.13, P = not significant). We conclude that measurement of gastric tonometer PCO2 yields excessively noisy and inaccurate data on the onset of gut anaerobic metabolism in hemorrhagic shock. Small bowel tonometer PCO2 is less noisy and, as a result, is superior in detecting gut hypoperfusion and the onset of anaerobic metabolism.

Gastric intramucosal acidosis in mechanically ventilated patients: role of mucosal blood flow

OBJECTIVE

To investigate whether gastric intramucosal acidosis is associated with a decreased gastric mucosal blood flow in mechanically ventilated patients.

DESIGN

Prospective, clinical investigation.

SETTING

University hospital intensive care unit.

PATIENTS

Seventeen mechanically ventilated patients with stable hemodynamic status.

INTERVENTIONS

Gastric tonometry and endoscopic assessment of mucosal blood flow.

MEASUREMENTS AND MAIN RESULTS

Six patients had gastric intramucosal acidosis (intramucosal pH [pHi] of 7.24 +/- 0.06), whereas the remaining 11 patients had pHi values within the normal range (7.44 +/- 0.01). No differences were found between intramucosal acidotic and nonacidotic patients with respect to their general and hemodynamic characteristics. Patients with intramucosal acidosis had a lower gastric mucosal blood flow, as assessed by laser-Doppler flowmetry, than nonacidotic patients (1.4 +/- 0.1 vs. 2.1 +/- 0.2 volts, respectively; p < .05). Reflectance spectrophotometry disclosed that patients with low gastric pHi had also a significantly (p < .05) lower hemoglobin content index (61 +/- 4 arbitrary units) than patients with normal pHi (81 +/- 3 arbitrary units), whereas oxygen saturation index was similar for both groups.

CONCLUSION

Our results support the hypothesis that gastric mucosal hypoperfusion underlies the development of intramucosal acidosis in mechanically ventilated patients.