2.50
Hdl Handle:
http://hdl.handle.net/2336/69093
Title:
Decreasing gut wall glucose as an early marker of impaired intestinal perfusion
Authors:
Krejci, Vladimir; Hiltebrand, Luzius; Büchi, Conradin; Ali, Syed Z; Contaldo, Claudio; Takala, Jukka; Sigurdsson, Gisli H; Jakob, Stephan M
Citation:
Crit. Care Med. 2006, 34(9):2406-14
Issue Date:
1-Sep-2006
Abstract:
OBJECTIVE: The aim of this study was to assess the microcirculatory and metabolic consequences of reduced mesenteric blood flow. DESIGN: Prospective, controlled animal study. SETTING: The surgical research unit of a university hospital. SUBJECTS: A total of 13 anesthetized and mechanically ventilated pigs. INTERVENTIONS: Pigs were subjected to stepwise mesenteric blood flow reduction (15% in each step, n = 8) or served as controls (n = 5). Superior mesenteric arterial blood flow was measured with ultrasonic transit time flowmetry, and mucosal and muscularis microcirculatory perfusion in the small bowel were each measured with three laser Doppler flow probes. Small-bowel intramucosal Pco2 was measured by tonometry, and glucose, lactate (L), and pyruvate (P) were measured by microdialysis. MEASUREMENTS AND MAIN RESULTS: In control animals, superior mesenteric arterial blood flow, mucosal microcirculatory blood flow, intramucosal Pco2, and the lactate/pyruvate ratio remained unchanged. In both groups, mucosal blood flow was better preserved than muscularis blood flow. During stepwise mesenteric blood flow reduction, heterogeneous microcirculatory blood flow remained a prominent feature (coefficient of variation, approximately 45%). A 30% flow reduction from baseline was associated with a decrease in microdialysis glucose concentration from 2.37 (2.10-2.70) mmol/L to 0.57 (0.22-1.60) mmol/L (p < .05). After 75% flow reduction, the microdialysis lactate/pyruvate ratio increased from 8.6 (8.0-14.1) to 27.6 (15.5-37.4, p < .05), and arterial-intramucosal Pco2 gradients increased from 1.3 (0.4-3.5) kPa to 10.8 (8.0-16.0) kPa (p < .05). CONCLUSIONS: Blood flow redistribution and heterogeneous microcirculatory perfusion can explain apparently maintained regional oxidative metabolism during mesenteric hypoperfusion, despite local signs of anaerobic metabolism. Early decreasing glucose concentrations suggest that substrate supply may become crucial before oxygen consumption decreases.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field
Additional Links:
http://dx.doi.org/10.1097/01.CCM.0000233855.34344.29

Full metadata record

DC FieldValue Language
dc.contributor.authorKrejci, Vladimir-
dc.contributor.authorHiltebrand, Luzius-
dc.contributor.authorBüchi, Conradin-
dc.contributor.authorAli, Syed Z-
dc.contributor.authorContaldo, Claudio-
dc.contributor.authorTakala, Jukka-
dc.contributor.authorSigurdsson, Gisli H-
dc.contributor.authorJakob, Stephan M-
dc.date.accessioned2009-05-27T09:27:47Z-
dc.date.available2009-05-27T09:27:47Z-
dc.date.issued2006-09-01-
dc.date.submitted2009-05-27-
dc.identifier.citationCrit. Care Med. 2006, 34(9):2406-14en
dc.identifier.issn0090-3493-
dc.identifier.pmid16878039-
dc.identifier.doi10.1097/01.CCM.0000233855.34344.29-
dc.identifier.urihttp://hdl.handle.net/2336/69093-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractOBJECTIVE: The aim of this study was to assess the microcirculatory and metabolic consequences of reduced mesenteric blood flow. DESIGN: Prospective, controlled animal study. SETTING: The surgical research unit of a university hospital. SUBJECTS: A total of 13 anesthetized and mechanically ventilated pigs. INTERVENTIONS: Pigs were subjected to stepwise mesenteric blood flow reduction (15% in each step, n = 8) or served as controls (n = 5). Superior mesenteric arterial blood flow was measured with ultrasonic transit time flowmetry, and mucosal and muscularis microcirculatory perfusion in the small bowel were each measured with three laser Doppler flow probes. Small-bowel intramucosal Pco2 was measured by tonometry, and glucose, lactate (L), and pyruvate (P) were measured by microdialysis. MEASUREMENTS AND MAIN RESULTS: In control animals, superior mesenteric arterial blood flow, mucosal microcirculatory blood flow, intramucosal Pco2, and the lactate/pyruvate ratio remained unchanged. In both groups, mucosal blood flow was better preserved than muscularis blood flow. During stepwise mesenteric blood flow reduction, heterogeneous microcirculatory blood flow remained a prominent feature (coefficient of variation, approximately 45%). A 30% flow reduction from baseline was associated with a decrease in microdialysis glucose concentration from 2.37 (2.10-2.70) mmol/L to 0.57 (0.22-1.60) mmol/L (p < .05). After 75% flow reduction, the microdialysis lactate/pyruvate ratio increased from 8.6 (8.0-14.1) to 27.6 (15.5-37.4, p < .05), and arterial-intramucosal Pco2 gradients increased from 1.3 (0.4-3.5) kPa to 10.8 (8.0-16.0) kPa (p < .05). CONCLUSIONS: Blood flow redistribution and heterogeneous microcirculatory perfusion can explain apparently maintained regional oxidative metabolism during mesenteric hypoperfusion, despite local signs of anaerobic metabolism. Early decreasing glucose concentrations suggest that substrate supply may become crucial before oxygen consumption decreases.en
dc.language.isoenen
dc.publisherLippincott Williams & Wilkinsen
dc.relation.urlhttp://dx.doi.org/10.1097/01.CCM.0000233855.34344.29en
dc.subject.meshAnimalsen
dc.subject.meshBalloon Occlusionen
dc.subject.meshBiological Markersen
dc.subject.meshCarbon Dioxideen
dc.subject.meshDuodenumen
dc.subject.meshGlucoseen
dc.subject.meshIntestinal Mucosaen
dc.subject.meshJejunumen
dc.subject.meshLactic Aciden
dc.subject.meshLaser-Doppler Flowmetryen
dc.subject.meshMesenteric Artery, Superioren
dc.subject.meshMesenteryen
dc.subject.meshMicrocirculationen
dc.subject.meshMuscle, Smooth, Vascularen
dc.subject.meshOxygen Consumptionen
dc.subject.meshPortal Veinen
dc.subject.meshProspective Studiesen
dc.subject.meshPyruvic Aciden
dc.subject.meshRegional Blood Flowen
dc.subject.meshSwineen
dc.titleDecreasing gut wall glucose as an early marker of impaired intestinal perfusionen
dc.typeArticleen
dc.contributor.departmentDepartment of Anesthesiology, Inselspital, Bern, Switzerland.en
dc.identifier.journalCritical care medicineen

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