Stahl K, Busch M, Maschke SK, Schneider A, Manns MP, Fuge J, Wiesner O, Meyer BC, Hoeper MM, Hinrichs JB, David S. A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival.
J Intensive Care Med 2019;
35:1162-1172. [PMID:
30909787 PMCID:
PMC7536530 DOI:
10.1177/0885066619837911]
[Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:
To analyze demography, clinical signs, and survival of intensive care
patients diagnosed with nonocclusive mesenteric ischemia (NOMI) and to
evaluate the effect of a local intra-arterial prostaglandin therapy.
Methods:
Retrospective observational study screening 455 intensive care patients with
acute arterial mesenteric perfusion disorder in a tertiary care hospital
within the past 8 years. Lastly, 32 patients with NOMI were enrolled, of
which 11 received local intra-arterial prostaglandin therapy. The diagnosis
of NOMI was based on the clinical presentation and established biphasic
computed tomography criteria. Clinical and biochemical data were obtained 24
hours before, at the time, and 24 hours after diagnosis.
Results:
Patients were 60.5 (49.3-73) years old and had multiple comorbidities. Most
of them were diagnosed with septic shock requiring high doses of
norepinephrine (NE: 0.382 [0.249-0.627] μg/kg/min). The Sequential Organ
Failure Assessment (SOFA) score was 18 (16-20). A decrease in oxygenation
(Pao2/Fio2), pH, and bicarbonate and an increase in international
normalized ratio, lactate, bilirubin, leucocyte count, and NE dose were
early indicators of NOMI. Median SOFA score significantly increased in the
last 24 hours before diagnosis of NOMI (16 vs 18, P <
.0001). Overall, 28-day mortality was 75% (81% nonintervention vs 64%
intervention cohort; P = .579). Median SOFA scores 24 hours
after intervention increased by +5% in the nonintervention group and
decreased by 5.5% in the intervention group (P =
.0059).
Conclusions:
Our data suggest that NOMI is a detrimental disease associated with
progressive organ failure and a high mortality. Local intra-arterial
prostaglandin application might hold promise as a rescue treatment strategy.
These data encourage future randomized controlled trials are desirable.
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