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Assessment of graded intestinal hypoperfusion and reperfusion using continuous saline tonometry in a porcine model.
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Anesthesiology and Intensive Care.
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Anesthesiology and Intensive Care.
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Anesthesiology and Intensive Care.ORCID iD: 0000-0002-5325-2688
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2004 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, Vol. 28, no 1, 79-88 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate effects of graded intestinal hypoperfusion and reperfusion on intestinal metabolic parameters as assessed by a modified continuous saline tonometry technique. MATERIALS: Twelve barbiturate-anaesthetized female pigs. METHODS: Measurements were performed prior to and during three predefined levels of superior mesenteric mean arterial blood pressure (P(SMA) 70, 50 and 30 mmHg, respectively, each 80 min long), obtained by an adjustable clamp around the origin of the superior mesenteric artery, and during reperfusion. We continuously measured jejunal mucosal perfusion (laser Doppler flowmetry), jejunal tissue oxygen tension (PO(2TISSUE); microoximetry) and intramucosal PCO(2) (continuous saline tonometry) and calculated net intestinal lactate production, mesenteric oxygenation, PCO(2) gap (jejunal mucosal PCO(2)-arterial PCO(2)) and pHi. RESULTS: At P(SMA) 70 and 50 mmHg mesenteric oxygen uptake and net lactate production remained unaltered, in spite of decreased oxygen delivery. At these P(SMA) levels PCO(2) gap increased, while pHi and PO(2TISSUE) decreased. At P(SMA) 30 mmHg pronounced increases in PCO(2) gap and mesenteric net lactate production as well as marked decreases in PO(2TISSUE) and pHi were demonstrated. Data indicate absence of anaerobic conditions at an intestinal perfusion pressure (IPP)> or =41 mmHg, a pHi> or =7.22 or PCO(2) gap< or =15.8 mmHg. CONCLUSIONS: Continuous saline tonometry detected intestinal ischemia as induced by graded reductions in IPP. A threshold could be defined above which intestinal ischemia does not occur.

Place, publisher, year, edition, pages
2004. Vol. 28, no 1, 79-88 p.
Keyword [en]
Animals, Blood Pressure/physiology, Cardiac Output/physiology, Female, Heart Rate/physiology, Intestines/blood supply/*metabolism, Manometry, Mesenteric Artery; Superior/metabolism, Models; Animal, Models; Cardiovascular, Oxygen Consumption/physiology, Regional Blood Flow/physiology, Reperfusion, Severity of Illness Index, Sodium Chloride/*pharmacology, Swine, Vascular Resistance/physiology
URN: urn:nbn:se:umu:diva-6007DOI: 10.1016/j.ejvs.2004.02.009PubMedID: 15177236OAI: diva2:145675
Available from: 2007-12-18 Created: 2007-12-18 Last updated: 2015-09-15Bibliographically approved
In thesis
1. Exploring Intestinal Ischemia: An experimental study
Open this publication in new window or tab >>Exploring Intestinal Ischemia: An experimental study
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: Unrecognized intestinal mucosal ischemia in severely ill patients may trigger development of multiple organ failure. Such ischemia can be evaluated by intraluminal tonometry reflecting mucosal PCO2 and intramucosal pH (pHi). The aims were to develop an apparatus for continuous saline tonometry (CST), to analyse circulatory control mechanisms during intestinal hypoperfusion and to evaluate the effect of dopexamine on intestinal circulation.

Methods: A modified standard tonometry catheter was integrated in a closed system with circulating saline. By measuring saline PCO2 in a measurement unit pHi could be calculated. This novel system was tested in vitro and in vivo. In a porcine study, CST was evaluated against standard saline tonometry, tissue oxygenation (PO2 TISSUE), jejunal mucosal perfusion (laser doppler flowmetry; LDF) and mesenteric net lactate flux during graded reductions of superior mesenteric arterial pressure (PSMA). Local control mechanisms for maintenance of intestinal oxygenation were analysed. Effects of dopexamine on the intestinal vascular bed were explored. Mucosal lactate production was assessed by microdialysis.

Results: CST measured accurate PCO2 values and changes in pHi during restricted intestinal circulation and at reperfusion. Local control mechanisms were insufficient at a PSMA of 30 mmHg, pHi was reduced to 7.10 and intestinal net lactate production was demonstrated. Absence of anaerobic intestinal metabolism was verified at PSMA ≥ 50 mmHg, pHi ≥ 7.22 and a PCO2 gap ≤ 15.8 mmHg. Dopexamine induced negative regional metabolic effects at the lowest PSMA, as expressed by decreased PO2 TISSUE and pHi, increased PCO2 gap and intestinal net lactate production.

Conclusions: CST reflected changes in pHi, induced by intestinal hypoperfusion and at reperfusion. Levels of PSMA, pHi and PCO2 gap as indicators of aerobic conditions were defined. Dopexamine induced a decrease of PO2 TISSUE and pHi as well as an increase in lactate flux at the lowest PSMA level.

Place, publisher, year, edition, pages
Umeå: Kirurgisk och perioperativ vetenskap, 2005. 59 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 938
Surgery, gastrointestinal tonometry, continuous, pig, pHi, intestinal ischemia, intestinal vascular bed, lactate, tissue oxygen tension, microdialysis, dopexamine, Kirurgi
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Research subject
urn:nbn:se:umu:diva-461 (URN)91-7305-788-6 (ISBN)
Public defence
2005-03-19, B, Tandläkarhögskolan, 9tr, Norrlands Universitetssjukhus, Umeå, 10:00 (English)
Available from: 2005-02-24 Created: 2005-02-24 Last updated: 2009-11-13Bibliographically approved

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Lehtipalo, StefanWinsö, OlaJohansson, GöranArnerlöv, Conny
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