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Perioperative intraperitoneal metabolic markers in patients undergoing cardiac surgery with cardiopulmonary bypass: an exploratory pilot study
Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic and Vascular Surgery.
Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery.
Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery.ORCID-id: 0000-0002-8461-5074
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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 

Tillgänglig från: 2019-03-20 Skapad: 2019-03-20 Senast uppdaterad: 2021-04-23Bibliografiskt granskad
Ingår i avhandling
1. The gastrointestinal tract in cardiac anaesthesia and intensive care: Clinical and experimental studies
Öppna denna publikation i ny flik eller fönster >>The gastrointestinal tract in cardiac anaesthesia and intensive care: Clinical and experimental studies
2021 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Gastrointestinal (GI) complications after cardiac surgery have a substantial impact on outcome. The aims were to investigate the frequency of, and methods for detecting, GI dysfunction after cardiac surgery and its relation to outcome, and the impact of vasoactive drugs on the GI tract in experimental cardiogenic shock. Paper I investigated the intraabdominal metabolism, using intraperitoneal microdialysis, during and after routine cardiac surgery in six patients. The results imply that, even during a normal perioperative course, the GI tract may be subjected to a subclinical anaerobic state. In Paper II the impact of stepwise reductions of cardiac output (CO) on the metabolism and circulation in the GI tract was studied in anaesthetised pigs using cardiac tamponade (n=6) or partial inflation of a caval vein balloon (n=6). The two models had similar haemodynamic effects and the intraabdominal metabolism became increasingly anaerobic when the CO was reduced by 50%. In Paper III the caval vein balloon model was utilised to examine the GI effects of two inodilators (levosimendan and milrinone) and two vasoconstrictors (vasopressin and norepinephrine) at 40% CO reduction (n=7/group). Negligible splanchnic vasodilation by the inodilators in fixed low CO, and possible GI specific side effects of high dose vasopressors, were demonstrated. Paper IV included 501 cardiac surgery patients assessed using the Acute Gastrointestinal Injury (AGI) grade. Only 32.7% were asymptomatic during the first three postoperative days. At least GI dysfunction, i.e. AGI grade ≥2, developed in 2.2% and was associated with more complex surgeries and higher postoperative frequencies of GI complications and mortality. In Paper V a biomarker for enterocyte damage, intestinal fatty acid-binding protein (IFABP), was investigated in relation to AGI grade. The group with AGI ≥2 (n=11) was compared to a matched group without GI symptoms (n=22). An I-FABP concentration in the fourth quartile on day one was associated with higher frequencies of organ dysfunction and 365-day mortality. In conclusion, this thesis provides evidence for an association between intraoperative GI injury, postoperative GI dysfunction and manifest complications, and that the effects of inodilators and vasoconstrictors must be considered.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University, 2021. s. 81
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 233
Nyckelord
Acute Gastrointestinal Injury grade, biomarkers, extracorporeal circulation, splanchnic perfusion, inotropic drugs, vasoactive drugs, lactate, lactate/pyruvate ratio
Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-88642 (URN)978-91-7529-378-3 (ISBN)
Disputation
2021-04-23, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2021-01-19 Skapad: 2021-01-19 Senast uppdaterad: 2022-08-26Bibliografiskt granskad

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Seilitz, JennyVidlund, MårtenAxelsson, BirgerNilsson, Kristofer F.

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