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Kalfadis S, Nalbanti V, Ioannidis O, Porfiriou G, Botsios D, Tsalis K. Variations of renal tissue oxygenation during abdominal compartment syndrome and sepsis. Adv Med Sci 2017; 62:177-185. [PMID: 28282605 DOI: 10.1016/j.advms.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/07/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE This experimental study was designed to evaluate the renal tissue oxygenation under the coexistence of abdominal compartment syndrome and sepsis. MATERIAL AND METHODS Fourteen non-breed dogs were divided into two groups: the control group (8) and the study group (6). Sepsis was established with intravenous endotoxin infusion at 100μg/kg for over 30min. Insufflation of CO2 in the peritoneal cavity was used for the increase in intra-abdominal pressure (IAP). A special catheter placed and fixed in the renal cortex at a depth of 3mm from the renal capsule was used for the measurement of renal tissue oxygenation. RESULTS Study parameters were recorded at the starting phase, at IAP of 15mmHg and 30mmHg and after decompression of the abdomen in the control group, and at the same intervals plus the induction of sepsis, prior to increasing abdominal pressure, in the study group. With the elevation of the IAP a reduction of renal tissue oxygenation presents itself, which is more pronounced in the presence of sepsis, especially for IAP over 15mmHg. Like other parameters, after abdominal decompression the renal tissue oxygenation returns to the initial levels, independently of sepsis. CONCLUSIONS The afferent arterioles vasoconstriction, which takes place during sepsis, and the intra-renal shunt, which occurs and leads to blood diversion to the medulla from the renal cortex due to the combination of intra-abdominal hypertension (IAH) and sepsis, seem to explain this finding.
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Affiliation(s)
- Stavros Kalfadis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vaia Nalbanti
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Orestis Ioannidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - George Porfiriou
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Botsios
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tsalis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
PURPOSE OF REVIEW The holy grail of circulatory monitoring is an accurate, continuous and relatively noninvasive means of assessing the adequacy of organ perfusion. This could be then advantageously used to direct therapeutic interventions to prevent both under-treatment and over-treatment and thus improve outcomes. However, in view of the heterogeneous response (adaptive or maladaptive) of different organs to various shock states, any monitor of perfusion adequacy cannot reflect every organ system, but should at least detect early deterioration in a 'canary' organ. Tissue oxygen tension reflects the balance between local oxygen supply and demand, and could thus be a potentially useful monitoring modality. This article examines the different technologies available and reviews the current literature regarding its utility as a monitor. RECENT FINDINGS Tissue oxygen tension, measured at a variety of sites in both human and laboratory studies, does appear to be a sensitive indicator of organ perfusion in different shock states. However, responses can vary not only between organs and between different shock states, but also over time. These changes reflect the particular oxygen supply-demand balance present in that tissue bed at that specific time point in the disease process. The response to a dynamic oxygen challenge test provides further information that allows severity to be more readily differentiated. SUMMARY Monitoring of tissue oxygen tension may offer a potentially useful tool for clinical management though significant validation needs to be first performed to confirm its promise.
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Venkatesh B, Morgan TJ, Hall J, Endre Z, Willgoss D. Subcutaneous gas tensions closely track ileal mucosal gas tensions in a model of endotoxaemia without anaerobism. Intensive Care Med 2005; 31:447-53. [PMID: 15703895 DOI: 10.1007/s00134-005-2558-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Accepted: 01/10/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Few comparative data exist on the responses of the subcutaneous and splanchnic circulations to evolving endotoxic shock. We therefore compared continuous subcutaneous pO(2) (pO(2sc)) and pCO(2) (pCO(2sc)) with simultaneous continuous gut luminal pCO(2) (pCO(2gi)) in an animal model of endotoxaemia and examined whether changes in gas tensions track tissue energy charge (EC). DESIGN Prospective observational study. SUBJECTS Fourteen anaesthetized rats, 7 controls and 7 experimental. INTERVENTIONS Controls were injected with saline, the experimental group with 20 mg/kg Klebsiella endotoxin. pCO(2sc), pO(2sc), and pCO(2gi) were measured continuously. Plasma lactate concentrations were measured at defined periods during the study. After 2 h ileal segments were snap frozen and assayed for tissue EC. MEASUREMENTS AND RESULTS Endotoxaemia resulted in a significant decrease in mean arterial blood pressure (132+/-9 to 71+/-20 mmHg) and pO(2sc) (71+/-23 to 33+/-22 torr) and a significant increase in pCO(2gi) (58+/-10 to 90+/-20 torr) and pCO(2sc) (56+/-6 to 81+/-25 torr). During endotoxaemia pCO(2gi) was directly correlated with pCO(2sc) (R (2)=0.5) and inversely correlated with pO(2sc) (R (2)=0.63). Plasma lactate concentrations were significantly elevated from baseline in the endotoxin limb. The mean EC was not significantly different in the two groups. CONCLUSIONS Both subcutaneous tissue gas tensions and intestinal luminal carbon dioxide tensions are rapidly responsive during evolving hypodynamic endotoxic shock. Alterations in tissue gas tensions were not associated with dysoxia.
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Affiliation(s)
- Bala Venkatesh
- Department of Intensive Care, University of Queensland, Princess Alexandra Hospital, Woolloongabba and Wesley Hospital, Australia.
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Abstract
Falciparum malaria is a complex disease with no simple explanation, affecting organs where the parasite is rare as well as those organs where it is more common. We continue to argue that it can best be understood in terms of excessive stimulation of normally useful pathways mediated by inflammatory cytokines, the prototype being tumor necrosis factor (TNF). These pathways involve downstream mediators, such as nitric oxide (NO) that the host normally uses to control parasites, but which, when uncontrolled, have bioenergetic failure of patient tissues as their predictable end point. Falciparum malaria is no different from many other infectious diseases that are clinically confused with it. The sequestration of parasitized red blood cells, prominent in some tissues but absent in others with equal functional loss, exacerbates, but does not change, these overriding principles. Recent opportunities to stain a wide range of tissues from African pediatric cases of falciparum malaria and sepsis for the inducible NO synthase (iNOS) and migration inhibitory factor (MIF) have strengthened these arguments considerably. The recent demonstration of bioenergetic failure in tissue removed from sepsis patients being able to predict a fatal outcome fulfils a prediction of these principles, and it is plausible that this will be demonstrable in severe falciparum malaria. Understanding the disease caused by falciparum malaria at a molecular level requires an appreciation of the universality of poly(ADP-ribose) polymerase-1 (PARP-1) and Na(+)/K(+)-ATPase and the protean effects of activation by inflammation of the former that include inactivation of the latter.
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Affiliation(s)
- Ian A Clark
- School of Biochemistry and Molecular Biology, Australian National University, ACT 0200, Canberra, Australia.
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Anning PB, Sair M, Winlove CP, Evans TW. Abnormal tissue oxygenation and cardiovascular changes in endotoxemia. Am J Respir Crit Care Med 1999; 159:1710-5. [PMID: 10351908 DOI: 10.1164/ajrccm.159.6.9801124] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Experimental sepsis induces disturbances in microcirculatory flow and nutrient exchange that may result in impaired tissue oxygenation. Volume resuscitation is a principal clinical intervention in patients with sepsis. Nitric oxide (NO) has been implicated in the pathophysiology of endotoxemia, but few data exist concerning the effects of either NO synthase inhibition (NOSi) or volume resuscitation on microvascular regulation and tissue oxygenation. Amperometric measurements were made of skeletal muscle (tissue) oxygen tension (PtO2) and its response to changes in fraction of inspired oxygen (FIO2) in rats rendered endotoxemic. Simultaneous measurements were made of systemic hemodynamic indices and arterial blood gas tensions. At normal PaO2, PtO2 in endotoxemic animals was significantly lower than in control animals, with marked attenuation of the response to increasing FIO2. These changes were associated with significant metabolic acidemia. In volume-resuscitated endotoxemic rats, PtO2 and blood pH were unchanged. A significant reduction in the PtO2 response to hyperoxia was observed in animals treated with the NOS inhibitor NG-nitro-L-arginine methyl ester (L-NAME), an effect not reversed by fluid resuscitation. These data suggest that significant tissue hypoxia and abnormal microvascular control occur in endotoxemia. Volume resuscitation can reverse the changes in PtO2, whereas nitric oxide synthase (NOS) inhibition has deleterious effects on muscle PtO2 in both control and endotoxemic animals.
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Affiliation(s)
- P B Anning
- Unit of Critical Care, and Physiological Flow Studies Group, Imperial College of Science, Technology and Medicine, London, United Kingdom
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Galley HF, Webster NR. Acidosis and tissue hypoxia in the critically ill: how to measure it and what does it mean. Crit Rev Clin Lab Sci 1999; 36:35-60. [PMID: 10094093 DOI: 10.1080/10408369991239178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We routinely monitor blood gases to determine the adequacy of ventilation and the presence of acid-base abnormalities. Changes in the blood are easily assessed, but of more importance is the abnormality at tissue level. Defects in acid-base homoeostasis have major effects on protein function, thus affecting tissue and organ performance. We concentrate on the changes seen in critically ill patients with acidosis because they form a large portion of the workload of the average intensive care unit. In addition, such patients have significant morbidity and mortality. The development of acidemia in the critically ill is often attributed to reductions in oxygen utilization, which in the past has generally been regarded as dysregulation of tissue blood supply. Resulting tissue hypoperfusion leads to anaerobic metabolism and lactic acidosis. Carbon dioxide production increases as anaerobically produced hydrogen ions are buffered by extracellular bicarbonate. The effectiveness of tissue perfusion is the target of much research, and in this review we outline factors that affect tissue acid-base status, techniques to measure tissue acid-base status, and explore the relationship between tissue acidosis and hypoxia in the critically ill. However, things are not always as simple as they may first appear.
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Affiliation(s)
- H F Galley
- Academic Unit of Anaesthesia and Intensive Care, University of Aberdeen, Foresterhill, Scotland
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Vollmar B, Rüttinger D, Menger MD. Monitoring of microvascular hemoglobin oxygenation in liver and skeletal muscle tissue of endotoxin-exposed rats using reflection spectrophotometry. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1998; 428:397-402. [PMID: 9500077 DOI: 10.1007/978-1-4615-5399-1_57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- B Vollmar
- Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
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Wagner MH, Segerer H, Koch H, Scheid A, Obladen M. Circulatory changes after surfactant bolus instillation in lung-lavaged adult rabbits. Exp Lung Res 1996; 22:667-76. [PMID: 8979049 DOI: 10.3109/01902149609070036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Following surfactant instillation in infants treated for respiratory distress syndrome, a mean arterial blood pressure (MABP) decrease is often observed. Its etiology and pathogenesis are still unknown. In this study various circulatory parameters were recorded continuously after surfactant instillation to elucidate the role of pulmonary vascular resistance as one possible cause for the MABP drop. Seven anesthetized adult New Zealand white rabbits were artificially ventilated after tracheotomy. Arterial and right atrial pressure were recorded continuously. Pulmonary artery pressure and cardiac output were determined by means of a thermodilution catheter. After inducing surfactant deficiency by repeated saline lavages, 200 mg/kg body weight of a natural surfactant preparation was administered by tracheal bolus instillation. PaO2 increased rapidly from 8.0 +/- 1.3 kPa to 51.2 +/- 8.8 kPa (mean +/- standard deviation) within 2 min (p < .05). MABP dropped from 12.1 +/- 1.9 kPa to 8.9 +/- 2.3 kPa within 2 min (p < .05). Pulmonary artery pressure, cardiac output, and right atrial pressure did not change during the observation period of 60 min. The results suggest that a peripheral vasodilatation is the most likely cause for the drop in MABP.
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Affiliation(s)
- M H Wagner
- Department of Neonatology, Virchow-Klinikum, Humboldt University, Berlin, Germany
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Affiliation(s)
- G Gutierrez
- Division of Pulmonary and Critical Care Medicine, University of Texas, Houston Health Science Center 77030, USA
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Singer M, Rosser D, Stidwill R. Bladder epithelial oxygen tension as a marker of organ perfusion. ACTA ANAESTHESIOLOGICA SCANDINAVICA. SUPPLEMENTUM 1995; 107:77-80. [PMID: 8599304 DOI: 10.1111/j.1399-6576.1995.tb04337.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London Medical School, Rayne Institute, UK
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Gutierrez G, Hurtado FJ, Fernandez E. Inhibitory effect of Escherichia coli endotoxin on skeletal muscle contractility. Crit Care Med 1995; 23:308-15. [PMID: 7867357 DOI: 10.1097/00003246-199502000-00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Endotoxemia in rabbits is associated with decreases in oxygen transport, tissue hypoxia, metabolic acidosis, and impaired oxygen extraction. In this study, we tested the hypothesis that endotoxin also inhibits skeletal muscle contractility directly. DESIGN Randomized animal study. SETTING Accredited animal research facility. SUBJECTS New Zealand white rabbits of either sex, weighing 2.55 +/- 0.20 kg. INTERVENTIONS We compared two groups of rabbits (n = 10 each) undergoing continuous electrical stimulation of the left hindlimb (maximal isometric twitch contraction at 0.25 Hz). One group (septic) was given an intravenous infusion of Escherichia coli endotoxin. The control group was subjected to decreases in cardiac output by inflating a balloon placed in the right ventricle. MEASUREMENTS AND MAIN RESULTS Endotoxin or balloon inflation resulted in comparable decreases in cardiac output (49% and 53%, respectively). Hindlimb oxygen transport decreased to similar values for both groups (4.9 +/- 0.3 and 4.2 +/- 0.5 mL/min/kg, respectively). Systemic oxygen extraction ratio was greater in the control group (0.72 +/- 0.03) than in the septic group (0.55 +/- 0.04; p < .05). There were no differences in hindlimb oxygen extraction ratio. Decreases in hindlimb forces were greater in the septic group (42 +/- 4%) than in the control group (18 +/- 3%, p < .01). Force frequency curves obtained at the beginning and the end of the experiment showed greater fatigue in the septic group. CONCLUSIONS The intravenous infusion of Escherichia coli endotoxin produces a direct inhibitory effect on skeletal muscle contractility in rabbits. This phenomenon is independent of decreases in oxygen transport and blood pH. Our data support the notion of a direct cellular effect of endotoxin, or of an associated cytokine, on skeletal muscle contractility. The mechanism responsible for this phenomenon is unknown.
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Affiliation(s)
- G Gutierrez
- Division of Pulmonary and Critical Care, University of Texas Health Science Center at Houston 77030
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Menger MD, Vollmar B, Messmer K. Sepsis and Nutritional Blood Flow. UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 1994. [DOI: 10.1007/978-3-642-85036-3_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Vallet B, Curtis SE, Lund N, Cain SM. [Intestinal mucosa injury during experimental endotoxin-induced shock]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1994; 13:675-84. [PMID: 7733517 DOI: 10.1016/s0750-7658(05)80724-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To ascertain tissue oxygenation during conversion from hypo to hyperdynamic state with vascular volume expansion, venous outflow from a segment of ileum was isolated in anesthetized and pump-ventilated endotoxic dogs to measure gut oxygen uptake (VO2), lactate metabolism, intramucosal PCO2 and tissue PO2 (PtiO2). Tissue PO2 was measured by multipoint surface Mehrdraht Dortmund Oberfläche electrodes placed on mucosal and serosal surfaces of gut. Six dogs were infused with 2 mg.kg-1 E. coli lipopolysaccharide (LPS) in one hour followed by a two hour 0.5 mL.kg-1.min-1 dextran infusion. Two dogs were used as controls and received dextran infusion in order to assess time and hemodilution-dependent effects. LPS infusion resulted in an hypodynamic sepsis with supply limited VO2, increased arterial lactate and increased lactate output by gut. Resuscitation resulted in an hyperdynamic sepsis with improvement of whole-body VO2. In the gut, VO2 remained low and intramucosal PCO2 as well as lactate output remained high, despite increased flow. Gut PtiO2 results suggested blood flow maldistribution with tissue hypoxia in the mucosa despite increased total flow to the gut. Gut VO2, lactate flux, intramucosal PCO2, and tissue PO2 were consistent with regulatory responses that shut down mucosal perfusion and oxygenation in spite of increased blood flow to gut.
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Affiliation(s)
- B Vallet
- Laboratoire de Pharmacologie, Faculté de Médecine du CHU de Lille
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