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Abstract
The impact of acute cardiac dysfunction on the gastrointestinal tract was investigated in anesthetized and instrumented pigs by sequential reductions of cardiac output (CO). Using a cardiac tamponade (n = 6) or partial inferior caval vein balloon inflation (n = 6), CO was controllably reduced for 1 h each to 75% (CO75%), 50% (CO50%), and 35% (CO35%) of the baseline value. Cardiac output in controls (n = 6) was not manipulated and maintained. Mean arterial pressure, superior mesenteric arterial blood flow, and intestinal mucosal perfusion started to decrease at CO50% in the intervention groups. The decrease in superior mesenteric arterial blood flow was non-linear and exaggerated at CO35%. Systemic, venous mesenteric, and intraperitoneal lactate concentrations increased in the intervention groups from CO50%. Global and mesenteric oxygen uptake decreased at CO35%. In conclusion, gastrointestinal metabolism became increasingly anaerobic when CO was reduced by 50%. Anaerobic gastrointestinal metabolism in low CO can be detected using intraperitoneal microdialysis.
Highlights
Ill patients and patients undergoing cardiac surgery frequently develop cardiac dysfunction with low cardiac output (CO) [1, 2]
Four of the six animals in the tamponade group died at CO35% and were only included in the statistical analyses until CO50% (Fig. 1b)
Two different methods to induce low CO states were used with the aim of simulating acute cardiac dysfunction
Summary
Ill patients and patients undergoing cardiac surgery frequently develop cardiac dysfunction with low cardiac output (CO) [1, 2]. Low CO causes impairment of splanchnic circulation, leading to loss of gastrointestinal (GI) mucosal barrier function and bacterial translocation, which may initiate, maintain, or aggravate a systemic inflammatory reaction [3]. These processes may progress to GI complications, which include GI bleeding, mesenteric ischemia, and pancreatitis [4,5,6]. The specific methods for detection of splanchnic anaerobic metabolism, e.g., intestinal intraluminal and intramural microdialysis, jejunal tonometry, and jejunal mucosal oxygen tension, used in these studies are predominantly applicable in experimental investigations. A pilot study of intraperitoneal microdialysis with measurements of lactate, pyruvate, glucose, and glycerol showed its feasibility in cardiac surgical patients [13], whereas it has not been investigated in low cardiac output models
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