Evaluation of splanchnic perfusion and oxygenation during positive end-expiratory pressure ventilation in relation to subcutaneous tissue gases and pH. An experimental study in pigs with oleic acid-induced lung injury.
Evaluation of splanchnic perfusion and oxygenation was performed by measurements of serosal tissue oxygen tension (PserO2) and intramucosal pH (pHi) in relation to subcutaneous oxygen tension (PscO2), subcutaneous carbon dioxide tension (PscCO2) and subcutaneous pH (pHsc) in pigs subjected to oleic acid-induced lung injury during ventilation with increasing levels of positive end-expiratory pressure (PEEP). Lung injury resulted in a general hypoxia and redistribution of perfusion away from the subcutaneous and splanchnic tissues, illustrated by a decrease in PaO2 from 93 to 37 mm Hg (p < 0.01), PscO2 from 45 to 17 mm Hg (p < 0.01), PserO2 from 80 to 30 mm Hg (p < 0.01) and pHi from 6.84 to 6.74 (p < 0.05) and a decrease of porta flow from 0.77 to 0.57 l/min. Application of PEEP up to 10-15 cm H2O resulted in an increase of portal vein oxygen tension (PportaO2) from 21 to 34 mm Hg (p < 0.01), PscO2 from 17 to 26 mm Hg (p < 0.05) and PserO2 from 30 to 55 mm Hg (p < 0.05). At PEEP 20 cm H2O PserO2 decreased to 47 mm Hg (p < 0.05). Porta flow decreased continuously with increasing levels of PEEP. PserO2 correlated with PportaO2 (r = 0.7, p < 0.001). pHi correlated poorly with PportaO2 (r = 0.2) and porta flow (r = 0.4). PscO2 and PserO2 correlated well (r = 0.8, p < 0.001). In summary, splanchnic perfusion and oxygenation was better reflected by serosal oxygen tension than pHi in the colon. Changes in serosal oxygenation of the colon paralleled changes in subcutaneous tissue oxygenation.
Jedlińska
B
B
Department of Anaesthesiology, Malmö University Hospital, Malmö, Sweden. jedlinski@swipnet.se
Mellström
A
A
Månsson
P
P
Hartmann
M
M
Jönsson
K
K
D000818:Animals; D003106:Colon / Q000378:metabolism*; D005740:Gases / Q000378:metabolism; D006863:Hydrogen-Ion Concentration; D007413:Intestinal Mucosa / Q000378:metabolism; D008171:Lung Diseases / Q000139:chemically induced / Q000503:physiopathology* / Q000628:therapy*; D019301:Oleic Acid; D010100:Oxygen / Q000378:metabolism*; D010313:Partial Pressure; D011175:Positive-Pressure Respiration; D012867:Skin / Q000378:metabolism*; D013152:Splanchnic Circulation; D013552:Swine
D005740:Gases; D019301:Oleic Acid; D010100:Oxygen