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Knuesel R, Takala J, Brander L, Haenggi M, Bracht H, Porta F, Jakob SM. Membrane microdialysis: Evaluation of a new method to assess splanchnic tissue metabolism. Crit Care Med 2006; 34:2638-45. [PMID: 16915109 DOI: 10.1097/01.ccm.0000239430.73826.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Measuring peritoneal lactate concentrations could be useful for detecting splanchnic hypoperfusion. The aims of this study were to evaluate the properties of a new membrane-based microdialyzer in vitro and to assess the ability of the dialyzer to detect a clinically relevant decrease in splanchnic blood flow in vivo. DESIGN A membrane-based microdialyzer was first validated in vitro. The same device was tested afterward in a randomized, controlled animal experiment. SETTING University experimental research laboratory. SUBJECTS Twenty-four Landrace pigs of both genders. INTERVENTIONS In vitro: Membrane microdialyzers were kept in warmed sodium lactate baths with lactate concentrations between 2 and 8 mmol/L for 10-120 mins, and microdialysis lactate concentrations were measured repeatedly (210 measurements). In vivo: An extracorporeal shunt with blood reservoir and roller pump was inserted between the proximal and distal abdominal aorta, and a microdialyzer was inserted intraperitoneally. In 12 animals, total splanchnic blood flow (measured by transit time ultrasound) was reduced by a median 43% (range, 13% to 72%) by activating the shunt; 12 animals served as controls. MEASUREMENTS AND MAIN RESULTS In vitro: The fractional lactate recovery was 0.59 (0.32-0.83) after 60 mins and 0.82 (0.71-0.87) after 90 mins, with no further increase thereafter. At 60 and 90 mins, the fractional recovery was independent of the lactate concentration. In vivo: Abdominal blood flow reduction resulted in an increase in peritoneal microdialysis lactate concentration from 1.7 (0.3-3.8) mmol/L to 2.8 (1.3-6.2) mmol/L (p = .006). At the same time, mesenteric venous-arterial lactate gradient increased from 0.1 (-0.2-0.8) mmol/L to 0.3 (-0.3 -1.8) mmol/L (p = .032), and mesenteric venous-arterial Pco2 gradients increased from 12 (8-19) torr to 21 (11-54) torr (p = .005). CONCLUSIONS Peritoneal membrane microdialysis provides a method for the assessment of splanchnic ischemia, with potential for clinical application.
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Affiliation(s)
- Rafael Knuesel
- Clinic for Intensive Care Medicine, University Hospital of Bern (Inselspital), Bern, Switzerland
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2
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Marik PE. Sublingual capnometry: a non-invasive measure of microcirculatory dysfunction and tissue hypoxia. Physiol Meas 2006; 27:R37-47. [PMID: 16705254 DOI: 10.1088/0967-3334/27/7/r01] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With improvement in supportive care patients rarely die from their presenting illness but rather from its sequela, namely sequential multi-organ failure. Tissue hypoxia is believed to be the causation of multi-organ dysfunction syndrome (MODS). The expedient detection and correction of tissue hypoxia may therefore limit the development of MODS. The standard oxygenation and hemodynamic variables (blood pressure, arterial oxygenation, cardiac output) which are monitored in critically ill patients are 'upstream' markers and provide little information as to the adequacy of tissue oxygenation. Global 'downstream' markers such as mixed venous oxygen saturation and blood lactate are insensitive indicators of tissue hypoxia. Sublingual PCO(2) is a regional marker of microvascular perfusion and tissue hypoxia that holds great promise for the risk stratification and end-point of goal directed resuscitation in critically ill patients. This paper reviews the technology and application of sublingual PCO(2) monitoring.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Clavijo-Alvarez JA, Sims CA, Menconi M, Shim I, Ochoa C, Puyana JC. Bladder Mucosa pH and Pco2 as a Minimally Invasive Monitor of Hemorrhagic Shock and Resuscitation. ACTA ACUST UNITED AC 2004; 57:1199-209; discussion 1209-10. [PMID: 15625450 DOI: 10.1097/01.ta.0000145484.40534.3b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuous monitoring of pH, Pco2, and Po2 using fiberoptic sensor technology has been proposed recently as a clinical monitor of the severity of shock and impaired tissue perfusion. Surrogates of gut tissue perfusion such as gastric tonometry, although cumbersome, have been used to indirectly quantify the degree of gut ischemia. The purpose of this study was to demonstrate the feasibility of monitoring bladder mucosa (BM) and to compare urinary bladder mucosa and proximal jejunum mucosa interstitial pH and Pco2 during hemorrhagic shock and resuscitation. METHODS Eleven male miniature swine (25-35 kg) (control, n = 4; shock, n = 7) underwent jejunal tonometry and cystostomy. A multisensor probe was placed adjacent to the BM. Urine was diverted. Normocarbia was maintained. Animals were hemorrhaged and kept at a mean arterial pressure of 40 mm Hg. When a constant infusion was required to maintain the mean arterial pressure at 40 mm Hg (decompensation), animals were resuscitated with shed blood plus two times the shed volume in lactated Ringer's solution (20 minutes) and observed for 2 hours. RESULTS During decompensation, BM pH values decreased significantly from 7.33 +/- 0.08 to 7.01 +/- 0.2 (p < 0.01) and recovered to 7.11 +/- 0.19 at 120 minutes after completion of resuscitation. During decompensation, BM Pco2 values increased significantly compared with baseline (from 49 +/- 6 mm Hg to 71 +/- 19 mm Hg, p < 0.05) and returned to baseline with resuscitation. Jejunum mucosa and BM interstitial Pco2 correlated throughout shock and resuscitation (r = 0.49). Bland-Altman analysis demonstrated significant differences between jejunum mucosa (intramucosal pH) and BM interstitial pH. CONCLUSION Shock-induced changes in the Pco2 of the BM are comparable to tonometric changes in the gut. These data suggest that continuous fiberoptic multisensor probe monitoring of the BM could potentially provide a minimally invasive method for the assessment of impaired tissue perfusion of the splanchnic circulation during shock and resuscitation.
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Affiliation(s)
- Julio A Clavijo-Alvarez
- Harvard Center for Minimally Invasive Surgery, Center of Integration of Medicine and Innovative Technology, Boston, Massachusetts, USA
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Marshall AP, West SH. Gastric tonometry and monitoring gastrointestinal perfusion: using research to support nursing practice. Nurs Crit Care 2004; 9:123-33. [PMID: 15152754 DOI: 10.1111/j.1478-5153.2004.00056.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The principles and physiological underpinnings of gastric tonometry are reviewed. Tonometric variables, including the PtCO2, pHi and CO2 gap, are described and critiqued as measurements of gastrointestinal perfusion. Increases in gastrointestinal CO2 unrelated to gastrointestinal hypoperfusion are discussed within different clinical contexts. The technical limitations of gastric tonometry, including procedural errors and PtCO2 measurement are discussed in relation to the accuracy of tonometric measurements. Tonometric measurement using semi-continuous air tonometry is introduced as a strategy to minimize technical limitations.
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Affiliation(s)
- Andrea P Marshall
- Department of Clinical Nursing, The University of Sydney, Sydney, Australia.
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Knuesel R, Jakob SM, Brander L, Bracht H, Siegenthaler A, Takala J. Changes in regional blood flow and pCO2 gradients during isolated abdominal aortic blood flow reduction. Intensive Care Med 2003; 29:2255-2265. [PMID: 13680116 DOI: 10.1007/s00134-003-1954-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2002] [Accepted: 07/15/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE pCO(2) gradients are used for the assessment of splanchnic regional and local mucosal blood flow changes in experimental and clinical research. pCO(2) gradients may not parallel blood flow changes because of concomitant changes in metabolism, hemoglobin, temperature, and the Haldane effect. DESIGN AND SETTING A randomized, controlled animal experiment in a university experimental research laboratory. INTERVENTIONS An extracorporeal shunt with reservoir and roller pump was inserted between the proximal and the distal abdominal aorta in 16 pigs. In animals randomized to the low-flow group ( n=8) splanchnic perfusion was reduced by running the roller pump. At baseline and after 45 min of stable shunt flow superior mesenteric artery, celiac trunk, spleen artery, and portal vein blood flows and regional venous-arterial and jejunal and gastric mucosal-arterial pCO(2) gradients were measured, and the respective regional O(2) consumption rates (VO(2)) calculated. MEASUREMENTS AND RESULTS In the low-flow group all regional blood flows and the associated VO(2) decreased to roughly 50% of baseline values, and hemoglobin decreased from 7.3 (4.4-9.6) g/dl to 5.7 (4.1-8.9) g/dl. Decreasing regional blood flows were consistently associated with increasing regional and mucosal pCO(2) gradients. CONCLUSIONS During isolated reduction in abdominal aortic blood flow there is no preferential distribution to any splanchnic vascular bed and changes in regional pCO(2) gradients reflect consistently the associated blood blow changes.
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Affiliation(s)
- Rafael Knuesel
- Department of Intensive Care Medicine, Inselspital, University Hospital Berne, 3010, Berne, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, University Hospital Berne, 3010, Berne, Switzerland.
| | - Lukas Brander
- Department of Intensive Care Medicine, Inselspital, University Hospital Berne, 3010, Berne, Switzerland
| | - Hendrik Bracht
- Department of Intensive Care Medicine, Inselspital, University Hospital Berne, 3010, Berne, Switzerland
| | - Andreas Siegenthaler
- Department of Intensive Care Medicine, Inselspital, University Hospital Berne, 3010, Berne, Switzerland
| | - Jukka Takala
- Department of Intensive Care Medicine, Inselspital, University Hospital Berne, 3010, Berne, Switzerland
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6
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Morgan TJ, Venkatesh B. The Case for Tissue Base Excess. Intensive Care Med 2003. [DOI: 10.1007/978-1-4757-5548-0_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Johnson D. Prevent hypotension and hypoxemia. Can J Anaesth 2002; 49:121-5. [PMID: 11823387 DOI: 10.1007/bf03020481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
A clinically feasible method for assessing regional splanchnic perfusion is still lacking. Methods used for research purposes demonstrate that the effects of current therapies on splanchnic perfusion are not predictable in intensive care patients with and without ARDS. Tonometry, laser Doppler flowmetry, and spectrophotometry have been used to assess splanchnic perfusion. Combining the available methods in different parts of the gastrointestinal tract may help assess splanchnic perfusion more accurately in the near future.
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Affiliation(s)
- Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital Inselspital, Bern, Switzerland.
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Abstract
PURPOSE To review multiple organ dysfunction syndrome with respect to: 1) clinical measurement systems; 2) molecular mechanisms; and 3) therapeutic directions based upon molecular mechanisms. METHODS The Medline, Cochrane, and Best Evidence databases (1996 to 2000), conference proceedings, bibliographies of review articles were searched for relevant articles. Key index words were multiple organ failure, multiple system organ dysfunction, sepsis, septic shock, shock, systemic inflammatory response syndrome. Outcomes prospectively defined were death and physiological reversal of end organ failure. RESULTS Multiple organ dysfunction/failure (MODS) is the most common cause for death in intensive care units. The recognition of this syndrome in the last 30 yr may be due to advances in early resuscitation unmasking these delayed sequelae in those that would have died previously. Multiple organ dysfunction occurs after shock of varied etiologies and may be the result of unbridled systemic inflammation. As yet, therapy directed to prevent or improve MODS has not dramatically altered outcomes. CONCLUSION Multiple organ dysfunction may serve as useful measure of disease severity for risk adjustment and outcome marker for quality of care and therapy provided. Anesthesiologists treating shock patients will note the subsequent development of MODS in the critical care unit and may be required to provide anesthetic support to these patients.
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Affiliation(s)
- D Johnson
- Department of Anesthesia, University of Saskatchewan, Saskatoon, Canada.
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Yamaura K, Akiyoshi K, Irita K, Taniyama T, Takahashi S. Effects of olprinone, a new phosphodiesterase inhibitor, on gastric intramucosal acidosis and systemic inflammatory responses following hypothermic cardiopulmonary bypass. Acta Anaesthesiol Scand 2001; 45:427-34. [PMID: 11300380 DOI: 10.1034/j.1399-6576.2001.045004427.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Phosphodiesterase (PDE) III inhibitors have both an inotropic and a peripheral vasodilatory effect, and also inhibit the activation of macrophages. Thus a newly developed PDE III inhibitor, olprinone, could modify gastric intramucosal pH (pHi), systemic oxygen consumption, and systemic inflammatory responses in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS We studied 23 patients. In 15 patients, olprinone (0.1 or 0.2 microg x kg(-1) x min(-1)) was administered from the commencement of CPB until their admission to the ICU. The other 8 patients received placebo. The pHi and regional CO2 tension (PrCO2) were assessed by a capnometric air tonometry. Systemic inflammatory responses were evaluated by serum interleukin-6 (IL-6), IL-10, and leucocyte counts. RESULTS The pHi and PCO2-gap, the difference between PrCO2 and arterial CO2 tension (PaCO2), showed a transient decrease and an increase after CPB, respectively. Although olprinone did not affect pHi, olprinone at 0.2 microg x kg(-1) x min(-1) significantly lessened post-CPB increase in PCO2-gap. Olprinone at 0.2 microg x kg(-1) x min(-1) significantly increased IL-10 and reduced the extent of leucocytosis, while it did not affect IL-6 levels. At the same dosage, olprinone also lessened the surge in systemic oxygen uptake index (VO2) and augmented the increase in mixed oxygen saturation (SvO2) both of which occurred after CPB. At 0.1 microg x kg(-1) x min(-1), however, olprinone did not show any significant effect. CONCLUSION Our results suggest that olprinone at 0.2 microg x kg(-1) x min(-1) suppresses gastric intramucosal acidosis and systemic inflammation following CPB.
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Affiliation(s)
- K Yamaura
- Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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11
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Yamaura K, Okamoto H, Akiyoshi K, Irita K, Taniyama T, Takahashi S. Effect of low-dose milrinone on gastric intramucosal pH and systemic inflammation after hypothermic cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2001; 15:197-203. [PMID: 11312479 DOI: 10.1053/jcan.2001.21954] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the usefulness of low-dose milrinone on gastric intramucosal pH (pHi) and systemic inflammation in patients undergoing hypothermic cardiopulmonary bypass (CPB). DESIGN Prospective randomized study. SETTING University hospital. PARTICIPANTS Twenty patients scheduled for cardiac surgery. INTERVENTIONS Ten patients were administered a low dose of milrinone, 0.25 microg/kg/min, from the initiation of CPB to 1 hour after admission to the intensive care unit. The other patients were administered saline. Supplemental inotropes and intravenous fluid were given to obtain adequate mean arterial blood pressure and pulmonary artery occlusion pressure. MEASUREMENTS AND RESULTS Gastric pHi and carbon dioxide pressure (PCO2) were assessed by capnometric air tonometry. The difference between PCO2 and arterial carbon dioxide pressure (PaCO2), PCO2-gap, was also examined. Systemic inflammatory responses were evaluated by serum interleukin-6 and leukocyte counts. Hemodynamics, oxygen delivery index, and oxygen uptake index were monitored with catheters in the radial and pulmonary arteries (thermodilution). The hepatic venous blood flow and left ventricular flow were measured using transesophageal echocardiography. Milrinone prevented gastric intramucosal acidosis, detected as a decrease in pHi or an increase in PCO2-gap, without affecting hepatic venous blood flow. Increases in interleukin-6, leukocyte count, and oxygen uptake index, all of which developed after CPB, were significantly less in the milrinone group than in the control group. CONCLUSION These results suggest that in patients undergoing hypothermic CPB, supplemental low-dose milrinone prevents gastric intramucosal acidosis and increases in some markers of systemic inflammation.
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Affiliation(s)
- K Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Yee J, Susanto I. Sublingual capnometry : in search of its holy grail. Chest 2000; 118:894-6. [PMID: 11035653 DOI: 10.1378/chest.118.4.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Yokota H, Yamamoto Y, Naoe Y, Fuse A, Sato H, Unemoto K, Kurokawa A. Measurements of cortical cellular pH by intracranial tonometer in severe head injury. Crit Care Med 2000; 28:3275-80. [PMID: 11008992 DOI: 10.1097/00003246-200009000-00025] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the cortical cellular damage in acute severe head injury, we measured the cortical cellular pH by using an intracranial tonometer made in our institution. DESIGN Prospective, 3.5-yr data collection. SETTING University hospital trauma intensive care unit. PATIENTS Severely head-injured patients (n = 29) with Glasgow Coma Scale score <8. INTERVENTION Routine emergency neurologic procedure. MEASUREMENTS AND MAIN RESULTS We made 98 measurements of cortical cellular pH by intracranial tonometer in 29 severely head-injured patients in the acute phase. Each patient's intracranial pressure was recorded, and in 16 patients, the saturation of jugular venous oxygen was monitored. The outcome at 6 months after injury was significantly better in patients having a cortical cellular pH of >7.2 than those with <7.2. The cerebral perfusion pressure and cortical cellular pH correlated significantly (p < .0001). CONCLUSIONS Our study suggests the usefulness of measurement of cortical cellular pH by intracranial tonometer for evaluating the severity of focal anaerobic cerebral metabolism and predicting patient prognosis.
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Affiliation(s)
- H Yokota
- Department of Emergency and Critical Care Medicine, Tama-Nagayama Hospital, Nippon Medical School, Tama-city, Tokyo, Japan
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Puyana JC, Soller BR, Parikh B, Heard SO. Directly measured tissue pH is an earlier indicator of splanchnic acidosis than tonometric parameters during hemorrhagic shock in swine. Crit Care Med 2000; 28:2557-62. [PMID: 10921594 DOI: 10.1097/00003246-200007000-00061] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare tissue pH in the stomach, bowel, and abdominal wall muscle during hemorrhagic shock and recovery using tissue electrodes; also, to compare tissue electrode pH measurements to gastric intramucosal pH (pHi), gastric luminal PCO2, and PCO2 gap (gastric luminal CO2--arterial CO2) measured with an air-equilibrated tonometer. DESIGN Prospective animal study. SETTING University animal research laboratory. SUBJECTS Eight anesthetized, mechanically ventilated Yorkshire swine. INTERVENTIONS Hemorrhagic shock was initiated by withdrawing blood over a 15-min period to lower systolic blood pressure to 45 mm Hg. Shock was maintained for 45 mins and was followed by a 5-min resuscitation to normal blood pressure with a blood/lactated Ringer's (1:2) mixture. Recovery was monitored for 60 mins. MEASUREMENTS AND MAIN RESULTS pH was measured with electrodes in the submucosa of the stomach, the submucosa of the small bowel, and the abdominal wall muscle. Gastric luminal PCO2 was measured with an air-equilibrated tonometer and pHi and PCO2 gap were calculated. Each organ showed a different sensitivity to shock and resuscitation. The bowel pH responded most rapidly to the onset of hemorrhagic shock and had the largest change in tissue pH. The bowel also showed the most rapid recovery during resuscitation. The submucosal pH of the stomach responded more slowly than the bowel, but faster than the abdominal wall muscle pH, gastric PCO2 gap, or pHi. The smallest changes in organ pH as a result of hemorrhagic shock were seen in the abdominal wall muscle and the stomach as assessed by gastric tonometry. CONCLUSIONS Direct measurement of tissue pH indicates that intra-abdominal organ pH varies during hemorrhagic shock. The small bowel pH changes the most in magnitude and rapidity compared with stomach pH or abdominal wall muscle pH. Tonometrically derived parameters were not as sensitive in the detection of tissue acidosis during shock and resuscitation as pH measured directly in the submucosa of the stomach or small bowel.
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Affiliation(s)
- J C Puyana
- Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA
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Mallinder PA, Hall JE, Bergin FG, Royle P, Leaper DJ. A comparison of opiate- and epidural-induced alterations in splanchnic blood flow using intra-operative gastric tonometry. Anaesthesia 2000; 55:659-65. [PMID: 10919421 DOI: 10.1046/j.1365-2044.2000.01475.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Several methods are available to measure splanchnic blood flow and gut ischaemia. Tonometry is most practical for peri-operative use. Epidural blockade from T5 to T11 causes mesenteric arteriovenous vasodilation and may increase splanchnic blood flow. This study assesses the ability of tonometry to measure differential effects of opiate and epidural analgesia on splanchnic blood flow. Forty patients for elective colorectal surgery were randomly allocated to receive epidural infusion or intravenous morphine. Gastric mucosal PCO2, pHi, standard pHi, PCO2 gap and pH gap were measured after induction and on termination of surgery. These parameters were within normal limits at the end in most cases and there was no significant difference between the groups. The complication rate was similar in both groups and was not correlated with low pHi, but was correlated with blood loss. We were unable to demonstrate a difference in splanchnic perfusion, as assessed by gastric tonometry, between the two groups.
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Affiliation(s)
- P A Mallinder
- North Tees Hospital, Stockton-on-Tees, Cleveland, UK
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Hepatosplanchnic perfusion. Curr Opin Crit Care 1999. [DOI: 10.1097/00075198-199906000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brinkmann A, Calzia E, Träger K, Radermacher P. Monitoring the hepato-splanchnic region in the critically ill patient. Measurement techniques and clinical relevance. Intensive Care Med 1998; 24:542-56. [PMID: 9681775 DOI: 10.1007/s001340050614] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- A Brinkmann
- Sektion Spezielle Anästhesiologie, Universitätsklinik für Anästhesiologie, Klinikum der Universität Ulm, Germany
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Tao W, Zwischenberger JB, Kramer GC. Rapid monitoring of gastrointestinal intraluminal PCO2 as an end-organ perfusion index. Crit Care Med 1997; 25:1458-9. [PMID: 9295816 DOI: 10.1097/00003246-199709000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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