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Temporal changes in tissue cardiorespiratory function during faecal peritonitis

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Abstract

Purpose

Sepsis affects both macro- and micro-circulatory transport of oxygen to tissues, causing regional hypoxia. However, this relationship is poorly characterized with respect to inter-organ variability, disease severity and the evolution to organ dysfunction. We hypothesized that an early circulatory insult precedes the development of organ dysfunction, and is more severe in predicted non-survivors. Consequently, we assessed temporal changes in myocardial function and regional tissue oxygenation in peripheral and deep organs in a rat model of faecal peritonitis. We also examined the utility of a dynamic oxygen challenge test to assess the microcirculation.

Methods

Awake, tethered, fluid-resuscitated male Wistar rats were randomized to receive intraperitoneal injection of faecal slurry, or to act as controls. At either 6 or 24 h post insult, rats were anaesthetized and underwent echocardiography, arterial cannulation and placement of tissue oxygen probes in peripheral (muscle, bladder) and deep (liver and renal cortex) organ beds. Measurements were repeated during fluid loading and an oxygen challenge test (administration of high oxygen concentrations).

Results

Early sepsis (6 h) was characterized by a fall in global oxygen delivery with concurrent decreases in muscle, renal cortical and, especially, liver tissue PO2. By contrast, during established sepsis (24 h), myocardial and circulatory function had largely recovered despite increasing clinical unwellness, hyperlactataemia and biochemical evidence of organ failure. O2 challenge revealed an early depression of response that, by 24 h, had improved in all organ beds bar the kidney.

Conclusions

This long-term septic model exhibited an early decline in tissue oxygenation, the degree of which related to predicted mortality. Clinical and biochemical deterioration, however, progressed despite cardiovascular recovery. Early circulatory dysfunction may thus be an important trigger for downstream processes that result in multi-organ failure. Furthermore, the utility of tissue PO2 monitoring to highlight the local oxygen supply–demand balance, and dynamic O2 challenge testing to assess microcirculatory function merit further investigation.

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Acknowledgments

A.D. and M.S. were funded by the Medical Research Council, UK. A.R. was supported by grants from the Swiss National Science Foundation, the Stiefel Zangger Foundation (Zurich, Switzerland) and the Siegenthaler Foundation (Zurich, Switzerland). The echocardiography equipment was funded by the British Heart Foundation, UK. This work was undertaken at UCL Hospitals/UCL, who receive support from the UK NIHR Biomedical Research Centre funding scheme. We thank Oxford Optronix for kindly providing the tPO2 probes.

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Authors and Affiliations

  1. Bloomsbury Institute of Intensive Care Medicine, Department of Medicine and Wolfson Institute for Biomedical Research, University College London, Cruciform Building, Gower St., London, WC1E 6BT, UK

    Alex Dyson, Alain Rudiger & Mervyn Singer

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  1. Alex Dyson
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  2. Alain Rudiger
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  3. Mervyn Singer
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Correspondence to Mervyn Singer.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-011-2229-x.

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134_2011_2227_MOESM1_ESM.ppt

Supplementary Fig. 1 Experimental protocol. Fluid infusion: 10 ml/kg/h infusion of 1:1 ratio of 6% hydroxyethyl starch and 5% glucose in normal saline. FB Fluid bolus, 6 h bolus; 25 ml/kg, 24 h bolus; 10 ml/kg of hydroxyethyl starch. Thereafter, the fraction of inspired oxygen (FiO2) was changed at 15 min intervals. Instrumentation, stabilization, fluid loading and oxygen challenge took approximately 2 h. (PPT 169 kb)

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Supplementary material 4 (DOC 35 kb)

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Dyson, A., Rudiger, A. & Singer, M. Temporal changes in tissue cardiorespiratory function during faecal peritonitis. Intensive Care Med 37, 1192–1200 (2011). https://doi.org/10.1007/s00134-011-2227-z

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  • DOI: https://doi.org/10.1007/s00134-011-2227-z

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