Splanchnic blood flow and oxygen uptake during cardiopulmonary bypass.
OBJECTIVE
To measure splanchnic blood flow (SBF) with 2 indicator dilution techniques during and after cardiopulmonary bypass (CPB), to compare the results with transesophageal echocardiography Doppler-measured right hepatic vein (RHV) flow, and to study gastric tonometry data in the same patients.


METHODS
Single-arm prospective study.


METHODS
University hospital operating room and intensive care unit.


METHODS
Ten adult patients undergoing cardiac surgery.


METHODS
SBF was measured using constant rate infusion of indocyanine green dye and low-dose ethanol from induction of anesthesia until end of hypothermic CPB. The infusion of ethanol was continued, and SBF was measured postoperatively at 2, 3, and 4 hours after CPB. Simultaneously, RHV flow, splanchnic oxygen delivery and uptake, and gastric mucosal pH were calculated.


RESULTS
SBF, RHV flow, and gastric mucosal pH remained unchanged during the study period. SBF measured with indocyanine green was 765 +/- 88 (SEM) mL/min after induction of anesthesia. SBF before CPB measured with ethanol was 985 +/- 218 mL/min. There was no significant difference between the methods. RHV flow was 450 +/- 87 mL/min after induction of anesthesia. There was no correlation between individual values of RHV flow and SBF. Splanchnic oxygen uptake was 52 +/- 7.8 mL/min after induction of anesthesia and decreased to 28 +/- 2.6 mL/min during CPB. Gastric mucosal pH was 7.32 +/- 0.02 after induction of anesthesia and showed no correlation to SBF or to splanchnic oxygen uptake.


CONCLUSIONS
SBF did not decrease during CPB. SBF could be measured with ethanol with reasonable accuracy. Transesophageal echocardiography assessment of RHV flow was not suitable to quantify SBF in the individual patient, but could be used to follow relative changes.
Gårdebäck
Michael
M
Department of Surgical Sciences, Karolinska Institute, Stockholm, Sweden. michael.gardeback@ks.se
Settergren
Göran
G
Brodin
Lars-Ake
LA
Jorfeldt
Lennart
L
Galuska
Dana
D
Ekberg
Karin
K
Wahren
John
J
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D002302:Cardiac Output; D002315:Cardiopulmonary Bypass; D004396:Coloring Agents; D017548:Echocardiography, Transesophageal; D000431:Ethanol; D005753:Gastric Mucosa / Q000378:metabolism; D006503:Hepatic Veins; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced; D007201:Indicator Dilution Techniques; D007208:Indocyanine Green; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D013152:Splanchnic Circulation
D004396:Coloring Agents; D000431:Ethanol; D007208:Indocyanine Green; D010100:Oxygen