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Intensive Care Medicine

, Volume 27, Issue 4, pp 757–766 | Cite as

Increased ileal-mucosal-arterial PCO2 gap is associated with impaired villus microcirculation in endotoxic pigs

  • I.F. Tugtekin
  • P. Radermacher
  • M. Theisen
  • M. Matejovic
  • A. Stehr
  • F. Ploner
  • K. Matura
  • C. Ince
  • M. Georgieff
  • K. Träger
Experimental

Abstract

Objective: To investigate whether an increased ileal-mucosal-arterial PCO2 gap (ΔPCO2) during hyperdynamic porcine endotoxemia is associated with impaired villus microcirculation. Design: Prospective, randomized, controlled, experimental study. Setting: Animal research laboratory. Animals: Twenty-two domestic pigs. Interventions: After baseline measurements, anesthetized and ventilated pigs received continuous i.v. endotoxin (ETX, n=12) for 24 h or placebo (SHAM, n=10). Measurements and results: Before, as well as 12 and 24 h after, the start of endotoxin or saline portal venous blood flow (QPV, ultrasound flow probe) and lactate/pyruvate ratios (L/P), the ileal-mucosal-arterial ΔPCO2 (fiberoptic sensor) and bowel-wall capillary hemoglobin O2 saturation (%Hb-O2-cap, remission spectrophotometry) were assessed together with intravital video records of the ileal-mucosal microcirculation (number of perfused/heterogeneously perfused/unperfused villi) using orthogonal polarization spectral imaging (CYTOSCAN A/R) via an ileostomy. At 12 and 24 h endotoxin infusion, about half of the evaluated villi were heterogeneously or unperfused which was paralleled by a progressive significant increase of the ileal-mucosal-arterial ΔPCO2 and portal venous L/P ratios, whereas QPV as well as both the mean %Hb-O2-cap and the %Hb-O2-cap frequency distributions remained unchanged. By contrast, in the SHAM-group, mucosal microcirculation was well-preserved, and none of the other parameters were influenced. Conclusions: We conclude that an increased ileal-mucosal-arterial ΔPCO2 during porcine endotoxemia is related to impaired villus microcirculation. A putative contribution of disturbed cellular oxygen utilization resulting from "cytopathic hypoxia" may also assume importance.

Endotoxin Ileal-mucosal-arterial PCO2 gap Orthogonal polarization spectral imaging Lactate/pyruvate ratios Remission spectrophotometry Villus microcirculation 

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Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • I.F. Tugtekin
    • 1
  • P. Radermacher
    • 1
  • M. Theisen
    • 1
  • M. Matejovic
    • 2
  • A. Stehr
    • 3
  • F. Ploner
    • 4
  • K. Matura
    • 5
  • C. Ince
    • 5
  • M. Georgieff
    • 1
  • K. Träger
    • 1
  1. 1.Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik für Anästhesiologie, Parkstrasse 11, 89075, Ulm, GermanyGermany
  2. 2.I. Interní Kliniky, Karlova Universita, Plzen, Czech RepublicCzech Republic
  3. 3.Klinik und Poliklinik für Chirurgie, Universitätsklinikum, Regensburg, GermanyGermany
  4. 4.Abteilung Anästhesiologie und Reanimation, Bezirkskrankenhaus, Sterzing, ItalyItaly
  5. 5.Afdeling Experimentele Anaesthesiologie, Academisch Medisch Centrum, Amsterdam, The NetherlandsThe Netherlands

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