JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (13) Citing Articles via Google Scholar Google Scholar Articles by Ratnaraj, J. Articles by Kurz, A. Search for Related Content PubMed PubMed Citation Articles by Ratnaraj, J. Articles by Kurz, A. Related Collections Airway Postanesthetic Care Unit Anesthetic Techniques

---

CRITICAL CARE AND TRAUMA

Supplemental Oxygen and Carbon Dioxide Each Increase Subcutaneous and Intestinal Intramural Oxygenation

Jebadurai Ratnaraj, MD^*, Barbara Kabon, MD^*, Michael R. Talcott, DVM, Daniel I. Sessler, MD, and Andrea Kurz, MD

Departments of *Anesthesiology and Veterinary Surgical Services, Washington University, St. Louis, MO; the Outcomes Research Institute and Departments of Anesthesiology and Pharmacology, University of Louisville, Louisville, KY; and the Department of Anesthesiology, University of Bern, Switzerland and the Department of Anesthesiology and Intensive Care Medicine, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Dr. Kurz, Department of Anesthesiology, University of Bern, 3010 Bern, Switzerland. Address email to kurza{at}notes.wustl.edu

Oxidative killing by neutrophils, a primary defense against surgical pathogens, is directly related to tissue oxygenation. We tested the hypothesis that supplemental inspired oxygen or mild hypercapnia (end-tidal PCO₂ of 50 mm Hg) improves intestinal oxygenation. Pigs (25 ± 2.5 kg) were used in 2 studies in random order: 1) Oxygen Study: 30% versus 100% inspired oxygen concentration at an end-tidal PCO₂ of 40 mm Hg, and 2) Carbon Dioxide Study: end-tidal PCO₂ of 30 mm Hg versus 50 mm Hg with 30% oxygen. Within each study, treatment order was randomized. Treatments were maintained for 1.5 h; measurements were averaged over the final hour. A tonometer inserted in the subcutaneous tissue of the left upper foreleg measured subcutaneous oxygen tension. Tonometers inserted into the intestinal wall measured intestinal intramural oxygen tension from the small and large intestines. Oxygen 100% administration doubled subcutaneous oxygen partial pressure (PO₂) (57 ± 10 to 107 ± 48 mm Hg, P = 0.006) and large intestine intramural PO₂ (53 ± 14 to 118 ± 72 mm Hg, P = 0.014); intramural PO₂ increased 40% in the small intestine (37 ± 10 to 52 ± 25 mm Hg, P = 0.004). An end-tidal PCO₂ of 50 mm Hg increased large intestinal PO₂ approximately 16% (49 ± 10 to 57 ± 12 mm Hg, P = 0.039), whereas intramural PO₂ increased by 45% in the small intestine (31 ± 12 to 44 ± 16 mm Hg, P = 0.002). Supplemental oxygen and mild hypercapnia each increased subcutaneous and intramural tissue PO₂, with supplemental oxygen being most effective.

IMPLICATIONS: Tissue oxygenation is the primary determinant of oxidative killing rate by neutrophils. Increasing inspired oxygen concentration from 30% to 100% or increasing end-tidal PCO₂ from 30 mm Hg to 50 mm Hg increased both subcutaneous or intestinal intramural tissue oxygenation, with supplemental oxygen being most effective. Either treatment is thus likely to reduce the risk of infection.

This article has been cited by other articles:

				S. Matsuzaki, M. Canis, J.-E. Bazin, C. Darcha, J.-L. Pouly, and G. Mage Effects of supplemental perioperative oxygen on post-operative abdominal wound adhesions in a mouse laparotomy model with controlled respiratory support Hum. Reprod., October 1, 2007; 22(10): 2702 - 2706. [Abstract] [Full Text] [PDF]

				O. Kimberger, E. Fleischmann, S. Brandt, A. Kugener, B. Kabon, L. Hiltebrand, V. Krejci, and A. Kurz Supplemental Oxygen, but Not Supplemental Crystalloid Fluid, Increases Tissue Oxygen Tension in Healthy and Anastomotic Colon in Pigs Anesth. Analg., September 1, 2007; 105(3): 773 - 779. [Abstract] [Full Text] [PDF]

				B. Kabon and D. I. Sessler Supplemental Intravenous Crystalloid Administration and Risk of Surgical Wound Infection Anesth. Analg., October 1, 2006; 103(4): 1040 - 1041. [Full Text] [PDF]

				B. Kabon, O. Akca, A. Taguchi, A. Nagele, R. Jebadurai, C. F. Arkilic, N. Sharma, A. Ahluwalia, S. Galandiuk, J. Fleshman, et al. Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection Anesth. Analg., November 1, 2005; 101(5): 1546 - 1553. [Abstract] [Full Text] [PDF]

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