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CRITICAL CARE AND TRAUMA

The Influence of Trauma and Ischemia on Carbohydrate Metabolites Monitored in Hamster Flap Tissue

Claudio Contaldo, MD^*, Jan Plock, MD^*, Valentin Djonov, MD, Michael Leunig, MD^*, Andrej Banic, MD, PhD^*, and Dominique Erni, MD^*

*Department of Orthopedic, Plastic and Hand Surgery, Inselspital, University Hospital, CH-3010 Berne, Switzerland; Institute of Anatomy, University of Berne, CH-3011 Berne, Switzerland

Address correspondence to Dominique Erni, MD, Department of Plastic and Reconstructive Surgery, Inselspital, University Hospital, CH-3010 Berne, Switzerland. Address e-mail to dominique.erni{at}insel.ch.

To monitor hypoperfusion of the peripheral tissues in critical illness caused by injury, we measured the concentrations of glucose, pyruvate, and lactate in traumatized and ischemic hamster flap tissue with the use of microdialysis. The interruption of the anatomic blood supply led to a drastic decrease in microvascular blood flow (laser Doppler flowmetry) and partial tissue oxygen tension (dye fluorescence quenching technique) in the ischemic part of the flap (both P < 0.01). In the traumatized area, blood flow, oxygen tension, and pyruvate were similar to the healthy control tissue throughout the experiments, whereas pyruvate was reduced in the ischemic tissue (P < 0.05 versus baseline and other tissues). Lactate was increased in both parts of the flap (P < 0.01 versus baseline and other groups for ischemic, not significant for traumatized). The sensitivity to detect ischemic hypoxia was 62% for lactate and 93% for lactate/pyruvate ratio (L/P) (P < 0.01). The specificity to discern ischemia-related from trauma-related changes was 71% for lactate and 70% for L/P (not significant). Our results suggest that L/P is more accurate than lactate for monitoring ischemia-related hypoxia after trauma. However, the rate of increased values originating from normally perfused but traumatized tissue was high for both markers.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999