VCURES Awarded Grant from Office of Naval Research to Determine Role of Sublingual Capnometry in Detecting Presence of Severity of Hemorrhage

The Office of Naval Research Casualty Care and Management Program has awarded VCURES a three-year grant for $760,000 to examine the utility of sublingual capnometry in hemorrhage and trauma. The grant entitled: Quantitative Studies of Sublingual PCO2 as a Resuscitative Endpoint in the Diagnosis and Treatment of Hemorrhagic Shock, will use a unique set of microcirculatory assessment tools to compare local blood flow and tissue oxygenation of the sublingual service of the tongue to other global and regional measures of tissue oxygenation. Sublingual capnometry is a technique that measures the level of carbon dioxide in the oral tissues under the tongue. Accumulation of carbon dioxide at this site has been demonstrated to be a marker of decreased blood flow in the setting of hemorrhage and other states of acute illness or injury.

Members of the team performing this research include:

Rao Ivatury, MD: Principal Investigator: Associate Director of VCURES. Professor of Surgery, Emergency Medicine and Physiology. Chairman Division of Trauma and Surgical Critical Care and Emergency Surgery VCU Department of Surgery

Kevin R. Ward, MD: Co-Principal Investigator: Associate Director of VCURES. Assistant Professor of Emergency Medicine and Physiology. Director of Research VCU Department of Emergency Medicine

R. Wayne Barbee, PhD: Co-Investigator: Senior VCURES Investigator. Assistant Professor of Emergency Medicine and Physiology. VCU Department of Emergency Medicine

Hakam Tiba, MD: Senior Research Associate. VCU Department of Emergency Medicine and VCURES

Bruce Spiess MD: Director of VCURES: Professor of Anesthesiology and Emergency Medicine. Vice Chairman VCU Department of Anesthesiology

Roland Pittman, PhD: Senior VCURES Investigator: Professor of Physiology and Emergency Medicine.

“This will be by far the most detailed study of the human microcirculation ever performed to our knowledge in the setting of acute injury. Sublingual capnometry is an exciting and potentially valuable tool in our armamentarium that may help provide clinicians and first responders more objective information concerning how critically injured a patient might be. However, it requires further study,” states Ivatury.

Dr. Ward adds “The tool set we have assembled will, for the first time, allow us to compare changes at the whole body level with changes occurring at a regional tissue level to determine which measure or combination of measures will most accurately reflect a state of physiologic distress so that health care providers can intervene earlier and more completely. This includes the use of orthogonal polarization spectral imaging which will actually allow us to visualize and record blood flow. This study will allow VCURES to study important changes in tissue oxygenation within minutes after injury, which is something that has not been done in the past. Such data may help us to develop even better monitoring tools as well as better treatment strategies in both the combat and civilian setting.”

This project is a part of the VCURES Operation Purple Heart Program which focuses on combat casualty care research. For more information please see: http://www.vcu.edu/vcures/purpleheart.htm or contact VCURES.