Jejunal and gastric mucosal perfusion versus splanchnic blood flow and metabolism: an observational study on postcardiac surgical patients.
OBJECTIVE
To evaluate the association between changes in total splanchnic and mucosal perfusion, assessed either by gastric tonometry or jejunal laser Doppler flowmetry in postcardiac surgical patients.


METHODS
A prospective, observational study.


METHODS
A general intensive care unit in a tertiary care center.


METHODS
Twelve, postoperative cardiac surgery patients were studied.


METHODS
Patients were treated according to clinical routine. Total splanchnic blood flow (indocyanine green extraction), jejunal mucosal perfusion (laser Doppler flowmetry), gastric mucosal-arterial PCO2 gradients, and splanchnic lactate uptake were studied during four 30-min measurements periods, each separated by a period of 1 hr.


RESULTS
There was no consistent association between either total splanchnic and local mucosal perfusion or between gastric and jejunal perfusion as assessed by two different techniques. The PCO2 gradient increased from 0.73+/-0.21 kPa to 1.15+/-0.30 kPa (p < .05), and splanchnic oxygen extraction increased from 40%+/-9% to 49%+/-14% (p < .01).


CONCLUSIONS
In this observational study on postcardiac surgical patients, local mucosal perfusion did not reflect total splanchnic blood flow and vice versa. Either changes in gastric and jejunal mucosal perfusion were different or increasing tissue metabolism was responsible for the observed lack of association between tonometry, laser Doppler flowmetry, and total splanchnic blood flow. Increasing mucosal arterial PCO2 gradient and splanchnic oxygen extraction may reflect a mismatch between splanchnic perfusion and metabolic demands.
Thorén
A
A
Department of Anesthesiology and Intensive Care, Salgrenska University Hospital, Göteborg, Sweden.
Jakob
S M
SM
Pradl
R
R
Elam
M
M
Ricksten
S E
SE
Takala
J
J
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001026:Coronary Artery Bypass; D003422:Critical Care; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply*; D007583:Jejunum / Q000098:blood supply*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D013152:Splanchnic Circulation / Q000502:physiology*