Redistribution of microcirculatory blood flow within the intestinal wall during sepsis and general anesthesia

2.50
Hdl Handle:
http://hdl.handle.net/2336/4589
Title:
Redistribution of microcirculatory blood flow within the intestinal wall during sepsis and general anesthesia
Authors:
Hiltebrand, Luzius B; Krejci, Vladimir; tenHoevel, Marcus E; Banic, Andrej; Sigurdsson, Gisli H
Citation:
Anesthesiology 2003, 98(3):658-69
Issue Date:
1-Mar-2003
Abstract:
BACKGROUND: Hypoperfusion of the intestinal mucosa remains an important clinical problem during sepsis. Impairment of the autoregulation of microcirculatory blood flow in the intestinal tract has been suggested to play an important role in the development of multiple organ failure during sepsis and surgery. The authors studied microcirculatory blood flow in the gastrointestinal tract in anesthetized subjects during early septic shock. METHODS: Eighteen pigs were intravenously anesthetized and mechanically ventilated. Regional blood flow in the superior mesenteric artery was measured with ultrasound transit time flowmetry. Microcirculatory blood flow was continuously measured with a six-channel laser Doppler flowmetry system in the mucosa and the muscularis of the stomach, jejunum, and colon. Eleven pigs were assigned to the sepsis group, while seven animal served as sham controls. Sepsis was induced with fecal peritonitis, and intravenous fluids were administered after 240 min of sepsis to alter hypodynamic sepsis to hyperdynamic sepsis. RESULTS: In the control group, all monitored flow data remained stable throughout the study. During the hypodynamic phase of sepsis, cardiac output, superior mesenteric artery flow, and microcirculatory blood flow in the gastric mucosa decreased by 45%, 51%, and 40%, respectively, compared to baseline (P < 0.01 in all). Microcirculatory blood flow in the muscularis of the stomach, jejunum, and colon decreased by 55%, 64%, and 70%, respectively (P < 0.001 in all). In contrast, flow in the jejunal and colonic mucosa remained virtually unchanged. During the hyperdynamic phase of sepsis, there was a threefold increase in cardiac output and superior mesenteric artery flow. Blood flow in the gastric, jejunal, and colonic mucosa also increased (22%, 24%, and 31% above baseline, respectively). Flow in the muscularis of the stomach returned to baseline, while in the jejunum and colon, flow in the muscularis remained significantly below baseline (55% and 45%, respectively, P< 0.01). CONCLUSIONS: It appears that in early septic shock, autoregulation of microcirculatory blood flow is largely intact in the intestinal mucosa in anesthetized pigs, explaining why microcirculatory blood flow remained virtually unchanged. This may be facilitated through redistribution of flow within the intestinal wall, from the muscularis toward the mucosa.
Additional Links:
http://gateway.uk.ovid.com/gw1/ovidweb.cgi?QS2=434f4e1a73d37e8c3511ef48f69b7c81718b3f5a9e050c865e22dc1081d386c5da419198b7414f6cc7b0131024501718f2b1bb86fd0926af8b547ebce3faf2fbf5e7977c1eefb5863c0b837894b7f99ce1b38af3b4db633caf425b6af43e805e62076814f5201e8f022300ff2df7c98ab0285d307753cfa1684726a8204b01bb5cadc86d90fe6a80c271d05f9ae29622fb8a2f7ae620f64d39a8df582e8a2fe932d193068cd6f06daa50c77b9f9611e2ff11030e7945abbb28dea57702299e6861251dada3ab53a1b07603c793261c6e05379467b57d5b3f664cfd2b5f690aafa2a744767f78627c7ead067a51b52f9a8bbce4ca08586330

Full metadata record

DC FieldValue Language
dc.contributor.authorHiltebrand, Luzius B-
dc.contributor.authorKrejci, Vladimir-
dc.contributor.authortenHoevel, Marcus E-
dc.contributor.authorBanic, Andrej-
dc.contributor.authorSigurdsson, Gisli H-
dc.date.accessioned2006-09-25T11:12:36Z-
dc.date.available2006-09-25T11:12:36Z-
dc.date.issued2003-03-01-
dc.identifier.citationAnesthesiology 2003, 98(3):658-69en
dc.identifier.issn0003-3022-
dc.identifier.pmid12606910-
dc.identifier.otherAAA12-
dc.identifier.urihttp://hdl.handle.net/2336/4589-
dc.description.abstractBACKGROUND: Hypoperfusion of the intestinal mucosa remains an important clinical problem during sepsis. Impairment of the autoregulation of microcirculatory blood flow in the intestinal tract has been suggested to play an important role in the development of multiple organ failure during sepsis and surgery. The authors studied microcirculatory blood flow in the gastrointestinal tract in anesthetized subjects during early septic shock. METHODS: Eighteen pigs were intravenously anesthetized and mechanically ventilated. Regional blood flow in the superior mesenteric artery was measured with ultrasound transit time flowmetry. Microcirculatory blood flow was continuously measured with a six-channel laser Doppler flowmetry system in the mucosa and the muscularis of the stomach, jejunum, and colon. Eleven pigs were assigned to the sepsis group, while seven animal served as sham controls. Sepsis was induced with fecal peritonitis, and intravenous fluids were administered after 240 min of sepsis to alter hypodynamic sepsis to hyperdynamic sepsis. RESULTS: In the control group, all monitored flow data remained stable throughout the study. During the hypodynamic phase of sepsis, cardiac output, superior mesenteric artery flow, and microcirculatory blood flow in the gastric mucosa decreased by 45%, 51%, and 40%, respectively, compared to baseline (P < 0.01 in all). Microcirculatory blood flow in the muscularis of the stomach, jejunum, and colon decreased by 55%, 64%, and 70%, respectively (P < 0.001 in all). In contrast, flow in the jejunal and colonic mucosa remained virtually unchanged. During the hyperdynamic phase of sepsis, there was a threefold increase in cardiac output and superior mesenteric artery flow. Blood flow in the gastric, jejunal, and colonic mucosa also increased (22%, 24%, and 31% above baseline, respectively). Flow in the muscularis of the stomach returned to baseline, while in the jejunum and colon, flow in the muscularis remained significantly below baseline (55% and 45%, respectively, P< 0.01). CONCLUSIONS: It appears that in early septic shock, autoregulation of microcirculatory blood flow is largely intact in the intestinal mucosa in anesthetized pigs, explaining why microcirculatory blood flow remained virtually unchanged. This may be facilitated through redistribution of flow within the intestinal wall, from the muscularis toward the mucosa.en
dc.language.isoenen
dc.publisherLippincott Williams & Wilkinsen
dc.relation.urlhttp://gateway.uk.ovid.com/gw1/ovidweb.cgi?QS2=434f4e1a73d37e8c3511ef48f69b7c81718b3f5a9e050c865e22dc1081d386c5da419198b7414f6cc7b0131024501718f2b1bb86fd0926af8b547ebce3faf2fbf5e7977c1eefb5863c0b837894b7f99ce1b38af3b4db633caf425b6af43e805e62076814f5201e8f022300ff2df7c98ab0285d307753cfa1684726a8204b01bb5cadc86d90fe6a80c271d05f9ae29622fb8a2f7ae620f64d39a8df582e8a2fe932d193068cd6f06daa50c77b9f9611e2ff11030e7945abbb28dea57702299e6861251dada3ab53a1b07603c793261c6e05379467b57d5b3f664cfd2b5f690aafa2a744767f78627c7ead067a51b52f9a8bbce4ca08586330en
dc.subject.lcshSwineen
dc.subject.meshAnesthesia, Generalen
dc.subject.meshAnimalsen
dc.subject.meshHydrogen-Ion Concentrationen
dc.subject.meshIntestinal Mucosaen
dc.subject.meshLactic Aciden
dc.subject.meshMicrocirculationen
dc.subject.meshOxygenen
dc.subject.meshRegional Blood Flowen
dc.subject.meshResearch Support, Non-U.S. Gov'ten
dc.subject.meshShock, Septicen
dc.titleRedistribution of microcirculatory blood flow within the intestinal wall during sepsis and general anesthesiaen
dc.typeArticleen
dc.identifier.journalAnesthesiologyen
dc.format.digYES-

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