Analysis of Intestinal Microvascular Permeability Associated with Cardiopulmonary Bypass

Abstract

Background.Cardiopulmonary bypass (CPB) is associated with a generalized inflammatory response and splanchnic edema formation that are thought to be related to microvascular barrier injury. In particular, intestinal edema and dysfunction have been associated with sepsis and post-CPB complications. The purpose of this study was to measure the forces determining fluid flux induced by CPB across the intestinal microvascular barrier.Materials and methods.An anesthetized canine model was used for this study (n= 12). To determine mesenteric microvascular permeability, a mesenteric lymphatic was cannulated and mesenteric venous pressure was elevated to 33 ± 1 mm Hg to reach a minimal lymph protein concentration (CL). With simultaneous measurement of plasma protein concentrations (CP), the reflection coefficient, ς, was calculated using the formula: ς = 1 −CL/CP. Capillary pressures (PC), lymph flow (QL), lymph protein flux, transvascular protein flux, and intestinal tissue water were all measured using standard techniques. Normothermic cardiopulmonary bypass with flows of 75–80 ml/kg/min was initiated after a steady state was achieved, and CPB was continued for 2 h and then discontinued. Measurements were repeated 30 min after CPB was discontinued. A second group (n= 5) was studied without mesenteric venous pressure elevation to evaluate the role of capillary pressure on the increased fluid flux seen with the initiation of CPB.Results.Initiation of CPB was associated with an increase in intestinal microvascular permeability. ς decreased from 0.77 ± 0.01 to 0.68 ± 0.01 (P< 0.05) with the initiation of CPB. This corresponded with statistically significant increases in both transvascular protein flux from 310 ± 22 to 465 ± 39 ml/min at 30 min and intestinal tissue water from 82.8 ± 0.7 to 84.3 ± 0.5% after weaning from CPB. Capillary pressure did not significantly increase with the initiation of CPB.Conclusions.Initiation of CPB results in a moderate increase in intestinal microvascular permeability to protein and an increase in intestinal tissue water. The increases in tissue water are not due to increased capillary pressure. A better understanding of the microvascular changes associated with extracorporeal circulation will facilitate the search for clinical interventions to minimize the impact of CPB.