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Measurements of Subcutaneous Tissue PO(2) Reflect Oxygen Metabolism of the Small Intestinal Mucosa during Hemorrhage and Resuscitation. An Experimental Study in Pigs.

Mellström, Åke LU ; Månsson, P; Jönsson, K and Hartmann, Michael LU (2009) In European Surgical Research 42(2). p.122-129
Abstract
Background: The first tissues to be deprived of perfusion and oxygenation in a hypovolemic situation and the last ones to be reperfused are the subcutaneous tissue and the gastrointestinal mucosa. We hypothesized that measurements of subcutaneous tissue gases and pH might reflect simultaneous changes in oxygenation of the intestinal mucosa. The aim of this study was to evaluate tissue gases and pH as measures of tissue oxygenation and tissue oxygen metabolism in subcutaneous and intestinal tissues simultaneously. Material and Methods: Five out of 17 domestic pigs (weight 21-25 kg) were used as controls without bleeding. Twelve animals were bled in 3 steps, 10% of their calculated blood volume at each step. The removed blood, crystalloid... (More)
Background: The first tissues to be deprived of perfusion and oxygenation in a hypovolemic situation and the last ones to be reperfused are the subcutaneous tissue and the gastrointestinal mucosa. We hypothesized that measurements of subcutaneous tissue gases and pH might reflect simultaneous changes in oxygenation of the intestinal mucosa. The aim of this study was to evaluate tissue gases and pH as measures of tissue oxygenation and tissue oxygen metabolism in subcutaneous and intestinal tissues simultaneously. Material and Methods: Five out of 17 domestic pigs (weight 21-25 kg) were used as controls without bleeding. Twelve animals were bled in 3 steps, 10% of their calculated blood volume at each step. The removed blood, crystalloid and colloid were thereafter infused, and animals were stabilized for 30 min. Measurements were made after each step of bleeding, retransfusion and stabilization. Before bleeding, all animals had a sensor (Paratrend 7trade mark) implanted subcutaneously in the left groin for measurements of tissue gases and pH (P(sc)O(2), P(sc)CO(2) and pH(sc)). Catheters were positioned in the jugular vein, portal vein, carotid artery, pulmonary artery and femoral artery for infusion, bleeding and oxygen monitoring. Via a midline laparotomy, 2 silicon tonometers (TRIPtrade mark sigmoid catheters) were positioned in the ileum and sigmoid colon for measurements of PCO(2) and pH (P(iI)CO(2), P(si)CO(2), pH(iI) and pH(si)). Blood flow in the portal vein was measured by an ultrasound probe (H6SB) and a Clark electrode (Cardiff tissue oxymeter) was used for serosal PO(2) measurements of the ileum (P(iI)O(2)) and sigmoid colon (P(si)O(2)). Results: After the first step of bleeding, P(sc)O(2) decreased from 64 +/- 17 to 56 +/- 22 mm Hg (SD; p < 0.05). P(sc)CO(2) and pH(sc) did not change. P(iI)CO(2) increased from 64 +/- 14 to 79 +/- 14 mm Hg (p < 0.05), P(si)CO(2) increased from 77 +/- 16 to 90 +/- 18 mm Hg (p < 0.05). pH(iI) decreased from 7.15 +/- 0.09 to 7.03 +/- 0.09 (p < 0.05). P(iI)O(2) and P(si)O(2) decreased, but not significantly until steps of further bleeding. After re-transfusion and stabilization, P(sc)O(2) and P(iI)CO(2) returned to baseline. Conclusion: Measurements of subcutaneous PO(2) are sensitive to bleeding and resuscitation and reflect oxygen metabolism in the small intestinal mucosa as measured by PCO(2) and pH. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Subcutaneous carbon dioxide tension, Subcutaneous oxygen tension, Subcutaneous pH, Intestinal pH(i), Shock, Serosal oxygen tension
in
European Surgical Research
volume
42
issue
2
pages
122 - 129
publisher
Karger
external identifiers
  • wos:000262900100009
  • pmid:19155629
  • scopus:58249143003
ISSN
0014-312X
DOI
10.1159/000193295
language
English
LU publication?
yes
id
57f82e8b-4589-4de2-a6a5-c4a0a71da162 (old id 1289470)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19155629?dopt=Abstract
date added to LUP
2009-02-04 12:50:11
date last changed
2017-01-01 04:36:30
@article{57f82e8b-4589-4de2-a6a5-c4a0a71da162,
  abstract     = {Background: The first tissues to be deprived of perfusion and oxygenation in a hypovolemic situation and the last ones to be reperfused are the subcutaneous tissue and the gastrointestinal mucosa. We hypothesized that measurements of subcutaneous tissue gases and pH might reflect simultaneous changes in oxygenation of the intestinal mucosa. The aim of this study was to evaluate tissue gases and pH as measures of tissue oxygenation and tissue oxygen metabolism in subcutaneous and intestinal tissues simultaneously. Material and Methods: Five out of 17 domestic pigs (weight 21-25 kg) were used as controls without bleeding. Twelve animals were bled in 3 steps, 10% of their calculated blood volume at each step. The removed blood, crystalloid and colloid were thereafter infused, and animals were stabilized for 30 min. Measurements were made after each step of bleeding, retransfusion and stabilization. Before bleeding, all animals had a sensor (Paratrend 7trade mark) implanted subcutaneously in the left groin for measurements of tissue gases and pH (P(sc)O(2), P(sc)CO(2) and pH(sc)). Catheters were positioned in the jugular vein, portal vein, carotid artery, pulmonary artery and femoral artery for infusion, bleeding and oxygen monitoring. Via a midline laparotomy, 2 silicon tonometers (TRIPtrade mark sigmoid catheters) were positioned in the ileum and sigmoid colon for measurements of PCO(2) and pH (P(iI)CO(2), P(si)CO(2), pH(iI) and pH(si)). Blood flow in the portal vein was measured by an ultrasound probe (H6SB) and a Clark electrode (Cardiff tissue oxymeter) was used for serosal PO(2) measurements of the ileum (P(iI)O(2)) and sigmoid colon (P(si)O(2)). Results: After the first step of bleeding, P(sc)O(2) decreased from 64 +/- 17 to 56 +/- 22 mm Hg (SD; p &lt; 0.05). P(sc)CO(2) and pH(sc) did not change. P(iI)CO(2) increased from 64 +/- 14 to 79 +/- 14 mm Hg (p &lt; 0.05), P(si)CO(2) increased from 77 +/- 16 to 90 +/- 18 mm Hg (p &lt; 0.05). pH(iI) decreased from 7.15 +/- 0.09 to 7.03 +/- 0.09 (p &lt; 0.05). P(iI)O(2) and P(si)O(2) decreased, but not significantly until steps of further bleeding. After re-transfusion and stabilization, P(sc)O(2) and P(iI)CO(2) returned to baseline. Conclusion: Measurements of subcutaneous PO(2) are sensitive to bleeding and resuscitation and reflect oxygen metabolism in the small intestinal mucosa as measured by PCO(2) and pH.},
  author       = {Mellström, Åke and Månsson, P and Jönsson, K and Hartmann, Michael},
  issn         = {0014-312X},
  keyword      = {Subcutaneous carbon dioxide tension,Subcutaneous oxygen tension,Subcutaneous pH,Intestinal pH(i),Shock,Serosal oxygen tension},
  language     = {eng},
  number       = {2},
  pages        = {122--129},
  publisher    = {Karger},
  series       = {European Surgical Research},
  title        = {Measurements of Subcutaneous Tissue PO(2) Reflect Oxygen Metabolism of the Small Intestinal Mucosa during Hemorrhage and Resuscitation. An Experimental Study in Pigs.},
  url          = {http://dx.doi.org/10.1159/000193295},
  volume       = {42},
  year         = {2009},
}