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Background  Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO 2 ) from arterial partial pressure carbon dioxide (artPCO 2 ) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO 2  and artPCO 2  (tc-artPCO 2 ) with the systemic oxygen metabolism and hemodynamic parameters. Our study aimed to test the hypothesis that tc-artPCO 2  can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation.    Methods  This prospective animal study was performed using female pigs at a university-based experimental laboratory. Progressive massive hemorrhagic shock was induced in mechanically ventilated pigs by stepwise blood withdrawal. All animals were then resuscitated by transfusing the stored blood in stages. A transcutaneous monitor was attached to their ears to measure tcPCO 2 . A pulmonary artery catheter (PAC) and pulse index continuous cardiac output (PiCCO) were used to monitor cardiac output (CO) and several hemodynamic parameters. The relationships of tc-artPCO 2  with the study parameters and systemic oxygen delivery (DO 2 ) were analyzed.    Results  Hemorrhage and blood transfusion precisely impacted hemodynamic and laboratory data as expected. The tc-artPCO 2  level markedly increased as CO decreased. There were significant correlations of tc-artPCO 2  with DO 2  and COs (DO 2 : r = − 0.83, CO by PAC: r = − 0.79; CO by PiCCO: r = − 0.74; all P < 0.0001). The critical level of oxygen delivery (DO 2crit ) was 11.72 mL/kg/min according to transcutaneous partial pressure of oxygen (threshold of 30 mmHg). Receiver operating characteristic curve analyses revealed that the value of tc-artPCO 2  for discrimination of DO 2crit  was highest with an area under the curve (AUC) of 0.94, followed by shock index (AUC = 0.78; P < 0.04 vs tc-artPCO 2 ), and lactate (AUC = 0.65; P < 0.001 vs tc-artPCO 2 ).    Conclusions  Our observations suggest the less-invasive tc-artPCO 2  monitoring can sensitively detect inadequate systemic oxygen supply during hemorrhagic shock. Further evaluations are required in different forms of shock in other large animal models and in humans to assess its usefulness, safety, and ability to predict outcomes in critical illnesses.

Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model