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Anesthesia & Analgesia, Vol 86, 22-27, Copyright © 1998 by International Anesthesia Research Society
Splanchnic oxygen transport and lactate metabolism during normothermic cardiopulmonary bypass in humans
M Haisjackl, J Birnbaum, M Redlin, M Schmutzler, F Waldenberger, H Lochs, W Konertz and W Kox
Department of Anesthesia and Intensive Care, University Hospital Charite, Humboldt University, Berlin, Germany.
The effect of normothermic (36.2 degrees C +/- 0.6 degree C) nonpulsatile
cardiopulmonary bypass (CPB) on splanchnic (hepatic) blood flow (SBF),
splanchnic oxygen transport (DO2spl) and oxygen consumption (VO2spl),
splanchnic lactate uptake and gastric mucosal pH (pHi, gastric tonometry)
was studied in 12 adults (New York Heart Association class II, ejection
fraction > or = 0.4) undergoing coronary artery surgery. SBF was
estimated with the constant-infusion indocyanine green (ICG) technique
using a hepatic venous catheter. DO2spl, VO2spl, and splanchnic lactate
uptake were calculated using the Fick principle after the induction of
anesthesia, during aortic cross-clamping, after CPB, and 2 and 7 h after
admission to the intensive care unit (ICU). SBF, DO2spl, and VO2spl did not
decrease during CPB but increased after ICU admission, whereas pHi
decreased 7 h after ICU admission. Initial ICG extraction was 0.78, which
decreased to 0.54 during aortic clamping and remained low thereafter. The
increased arterial blood lactate concentrations were not associated with a
decreased splanchnic lactate uptake. We conclude that normothermic CPB is
not associated with deterioration in the global intestinal oxygen supply.
The increase of blood lactate levels and the decrease in ICG extraction, as
well as in pHi, are consistent with a systemic inflammatory response to
CPB. Implications: This study demonstrated that normothermic
cardiopulmonary bypass (at flows > 2.4 L.min-1.m-2) was not associated
with deterioration in global intestinal oxygen delivery, which suggests
that increased blood lactate concentrations and decreased gastric mucosal
pH and indocyanine green extraction are manifestations of a systemic
inflammatory response to cardiopulmonary bypass.
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