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Monitoring of Splanchnic Regional Perfusion: An Experimental Study of New Application and Validation
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Systemic infection, major surgery, trauma and many other causes can lead to impaired organ function. Compensated shock is not detected by global hemodynamic and oxygen measurements, as they take no account for regional variations. Focus has therefore gradually turned from looking at systemic changes to selective investigations of regional blood flow and ischemia. This thesis presents a series of experiments evaluating new application and validation of various monitoring techniques.

An experimental porcine model with anesthetized and invasively monitored animals was used. The circulatory interventions included endotoxin infusion (septic shock), aortic constriction and selective clamping of splanchnic arteries. The aim was to compare air with saline tonometry, to validate the intraperitoneal use of tonometry and to reexamine the use of endoluminal reflectance pulse oxymetry. To investigate the relative contributions of regional blood flow and detection of ischemia, measurements of hepatic venous oxygen saturation (ShvO2), lactate concentrations and PCO2 gap were used.

Our findings support the use of air instead of saline as the preferred technique for tonometric measurements. With the intraperitoneal application of tonometry we gain more information on regional aspects of the splanchnic circulation, and it appears to be a reliable monitoring option for early detection of ischemia in the small intestine. Measurements of ShvO2 will give an overall reflection of the intestinal circulation. The sigmoid colonic pulse oximetry showed a non-linear response in relation to regional blood flow, and will therefore not be able to detect gradual changes in oxygen saturation. Determination of the regional to endtidal PCO2 gap might prove valuable for monitoring of the intestinal circulation.

Because of sophisticated interactions between portal and hepatic arterial blood flow and hepatic compensation for regional ischemia, a combination of monitoring techniques might be needed. The results of this study will hopefully encourage clinical evaluation of intraperitoneal tonometry and endtidal PCO2 gap recordings for non-invasive, semi-continuous, trend monitoring of the splanchnic circulation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2003. , p. 32
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1291
Keywords [en]
Anaesthesiology and intensive care, Splanchnic circulation, Regional ischemia, Hepatic artery buffer response, Air tonometry, Intraperitoneal, Reflectance pulse oximetry, Hepatic venous oxygen saturation, Lactate, PCO2 gap
Keywords [sv]
Anestesiologi och intensivvård
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-3611ISBN: 91-554-5760-6 (print)OAI: oai:DiVA.org:uu-3611DiVA, id: diva2:163452
Public defence
2003-11-06, Boströmsalen, University Hospital, entrance 30, Uppsala, 13:15
Opponent
Supervisors
Available from: 2003-10-16 Created: 2003-10-16Bibliographically approved
List of papers
1. Intraperitoneal and sigmoid colon tonometry in porcine hypoperfusion and endotoxin shock models
Open this publication in new window or tab >>Intraperitoneal and sigmoid colon tonometry in porcine hypoperfusion and endotoxin shock models
1999 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 43, no 7, p. 702-707Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90926 (URN)
Available from: 2003-10-16 Created: 2003-10-16 Last updated: 2015-06-09Bibliographically approved
2. Intraperitoneal tonometry for detection of regional enteric ischemia
Open this publication in new window or tab >>Intraperitoneal tonometry for detection of regional enteric ischemia
2000 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 44, no 8, p. 985-990Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90927 (URN)
Available from: 2003-10-16 Created: 2003-10-16 Last updated: 2015-06-09Bibliographically approved
3. Sigmoid colonic reflectance pulse oximetry and tonometry in a porcine experimental hypoperfusion shock model
Open this publication in new window or tab >>Sigmoid colonic reflectance pulse oximetry and tonometry in a porcine experimental hypoperfusion shock model
2002 In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 46, no 10, p. 1212-1216Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-90928 (URN)
Available from: 2003-10-16 Created: 2003-10-16Bibliographically approved
4. Experimental evaluation of hepatic venous oxygen saturation and lactate measurements in varying splanchnic perfusion
Open this publication in new window or tab >>Experimental evaluation of hepatic venous oxygen saturation and lactate measurements in varying splanchnic perfusion
(English)Manuscript (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90929 (URN)
Available from: 2003-10-16 Created: 2003-10-16 Last updated: 2015-06-09Bibliographically approved

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Citation style
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