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Ileal microcirculation and mucosal acidosis during hyperdynamic porcine endotoxemia

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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

References

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Acknowledgement

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

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Tugtekin, I., Matejovic, M., Stehr, A. et al. Ileal microcirculation and mucosal acidosis during hyperdynamic porcine endotoxemia. Crit Care 4, P146 (2000). https://doi.org/10.1186/cc866

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Keywords

  • Ileal
  • Bowel Wall
  • Sustained Increase
  • Hydroxyethylstarch
  • Flow Probe