Perioperative intraperitoneal metabolic markers in patients undergoing cardiac surgery with cardiopulmonary bypass: an exploratory pilot studyVisa övriga samt affilieringar
2019 (Engelska)Ingår i: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 34, nr 7, s. 552-560Artikel i tidskrift (Refereegranskat) 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.
Ort, förlag, år, upplaga, sidor
Sage Publications, 2019. Vol. 34, nr 7, s. 552-560
Nyckelord [en]
Extracorporeal circulation, gastrointestinal metabolism, glucose, glutamate, glycerol, intraperitoneal microdialysis, lactate, pyruvate, splanchnic hypoperfusion
Nationell ämneskategori
Kardiologi Gastroenterologi
Identifikatorer
URN: urn:nbn:se:oru:diva-73247DOI: 10.1177/0267659119835463ISI: 000485294500004PubMedID: 30880576Scopus ID: 2-s2.0-85063157841OAI: oai:DiVA.org:oru-73247DiVA, id: diva2:1297633
Forskningsfinansiär
Svenska Sällskapet för Medicinsk Forskning (SSMF)
Anmärkning
Funding Agencies:
Research Committee of Region Örebro County
ALF Grants at Region Örebro County
2019-03-202019-03-202021-04-23Bibliografiskt granskad
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