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Perioperative intraperitoneal metabolic markers in patients undergoing cardiac surgery with cardiopulmonary bypass: an exploratory pilot study
Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.ORCID iD: 0000-0002-8461-5074
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2019 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 34, no 7, p. 552-560Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiopulmonary bypass and postoperative cardiac dysfunction cause splanchnic hypoperfusion resulting in intra-abdominal anaerobic metabolism and risk for gastrointestinal complications. The intra-abdominal metabolism can be monitored by intraperitoneal measurement of relevant metabolites using microdialysis. The aim of this study was to investigate the intraperitoneal metabolism using microdialysis during and after cardiopulmonary bypass at 34°C.

METHODS: In six patients undergoing elective coronary artery bypass grafting or aortic valve replacement under cardiopulmonary bypass, microdialysis was used to measure intraperitoneal and subcutaneous glucose, lactate, pyruvate, glycerol and glutamate concentrations, intraoperatively and up to 36 hours postoperatively. Arterial and central venous blood gases were analysed as were haemodynamics and the development of complications.

RESULTS: All patients had an ordinary perioperative course and did not develop gastrointestinal complications. The arterial, intraperitoneal and subcutaneous lactate concentrations changed during the perioperative course with differences between compartments. The highest median (interquartile range) concentration was recorded in the intraperitoneal compartment at 1 hour after the end of cardiopulmonary bypass (2.1 (1.9-2.5) mM compared to 1.3 (1.2-1.7) mM and 1.5 (1.0-2.2) mM in the arterial and subcutaneous compartments, respectively). In parallel with the peak increase in lactate concentration, the intraperitoneal lactate/pyruvate ratio was elevated to 33.4 (12.9-54.1).

CONCLUSION: In cardiac surgery, intraperitoneal microdialysis detected changes in the abdominal metabolic state, which were more pronounced than could be shown by arterial blood gas analysis. Despite an uneventful perioperative course, patients undergoing low-risk surgery under cardiopulmonary bypass might be subjected to a limited and subclinical intra-abdominal anaerobic state.

Place, publisher, year, edition, pages
Sage Publications, 2019. Vol. 34, no 7, p. 552-560
Keywords [en]
Extracorporeal circulation, gastrointestinal metabolism, glucose, glutamate, glycerol, intraperitoneal microdialysis, lactate, pyruvate, splanchnic hypoperfusion
National Category
Cardiac and Cardiovascular Systems Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-73247DOI: 10.1177/0267659119835463ISI: 000485294500004PubMedID: 30880576OAI: oai:DiVA.org:oru-73247DiVA, id: diva2:1297633
Funder
Swedish Society for Medical Research (SSMF)
Note

Funding Agencies:

Research Committee of Region Örebro County  

ALF Grants at Region Örebro County 

Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2019-11-12Bibliographically approved

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Seilitz, JennyAxelsson, BirgerNilsson, Kristofer F.

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