Volume 4 Supplement 1

20th International Symposium on Intensive Care and Emergency Medicine

Open Access

Ileal microcirculation and mucosal acidosis during hyperdynamic porcine endotoxemia

  • I Tugtekin1,
  • M Matejovic2,
  • A Stehr3,
  • M Theisen1,
  • F Ploner4,
  • K Träger1,
  • M Georgieff1 and
  • P Radermacher1
Critical Care20004(Suppl 1):P146

DOI: 10.1186/cc866

Published: 21 March 2000

Full text

Introduction

The tonometric determination of the arterial-mucosal PCO2-gap (Δa-rPCO2) is used to monitor adequacy of gastrointestinal perfusion. As PrCO2 also integrates other phenomena [1], we analyzed the influence of the intestinal villus microcirculation on increased Δa-rPCO2during long-term hyperdynamic porcine endotoxemia.

Material and methods

Anesthetized and ventilated pigs received continuous i.v. endotoxin (ETX, n=12) for 24 h or placebo (Sham, n=6). Hydroxyethylstarch was infused to maintain MAP >65 mmHg together with a sustained increase in cardiac output [2]. Before the start of ETX (0 h), as well as 12 and 24 h afterwards, portal venous blood flow (Qpv, ultrasound flow probes) and lactate/pyruvate-ratios (L/P pv), ileal mucosal Δa-rPCO2 (fiberoptic sensor)and bowel wall capillary Hb-O2-saturation (Hb-O2cap,remission spectrophotometry) were assessed together with intravital video records of the ileal mucosal microcirculation (number of perfused/not-perfused villi) by orthogonal polarization-spectrometry (Cytoscan) [3] obtained via an ileostomy.

Results

See Table. Median(25/75%); #P<0.05 vs 0 h (Friedman-Anova); §P<0.05 ETX vs Sham (Mann-Whitney).

Conclusion

Taking into account the unchanged portal venous blood flow, the progressive increase in Δa-rPCO2 is mainly due to the heterogeneity of capillary villus perfusion. We can only speculate about the putative additional influence of a disturbed intracellular O2-utilisation.
Table

abstarct

  

0 h ETX

12 h ETXk

24 h ETX

Qpv ml/kgxmin

ETX

24(21,27)

27(22,31)

26(20,31)

 

Sham

22(18,25)

26(25,29)

25(22,29)

Hb-O2cap % (± S.D.)

ETX

51± 16

53± 16

53± 11

 

Sham

53± 15

53± 10

44± 13

Δa-rPCO2 mmHg

ETX

15(8,17)

18(15,26)#

22(16,33)#

 

Sham

14(9,17)

14(10,16)§

13(10,20)

L/P pv

ETX

14(13,17)

19(17,22)#

26(21,31)#

 

Sham

11(10,13)

13(8,19)

14(10,25)

n (Villi) perfused/not perfused

ETX

60(48;74)/0(0;0)

33(6;52)/28(18;42)#§

32(23;38)/22(10;35) #§

 

Sham

73(66;130)/0(0;0)

62(54;82)/6(2;11)§

55(27;100)/0(0;4)§

Declarations

Acknowledgement

Supported by *ESICM, Deutsche Forschungsgemein-schaft and Provinz Bozen-Südtirol (Italy). Cytoscan is a trademark of Cytometrics Inc., Philadelphia, PA.

Authors’ Affiliations

(1)
Department of Anesthesia, Univ. Hospital
(2)
Department of Intensive Care, Charles-University
(3)
Department of Surgery, Univ. Hospital
(4)
Department of Anesthesia, District Hospital

References

  1. Brinkmann , et al.: . Intensive Care Med 1998, 24: 542-. 10.1007/s001340050614PubMedView ArticleGoogle Scholar
  2. Träger , et al.: . AJRCCM 1999, 159: 1758-.Google Scholar
  3. Groner , et al.: . Nat Med 1999, 10: 1209-.Google Scholar

Copyright

© Current Science Ltd 2000

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