J J Tenhunen1, S M Jakob, J A Takala. 1. Critical Care Research Program, Division of Intensive Care, Department of Anesthesiology and Intensive Care, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland. jyrki.tenhunen@kuh.fi
Abstract
OBJECTIVES: Gut ischemia induced by occlusion of the superior mesenteric artery (SMA) results in release of lactate into the gut lumen. We studied the threshold of SMA flow reduction that leads to increased gut luminal lactate during stepwise reduction in SMA blood flow. DESIGN AND SETTING: A randomized, controlled animal experiment in a university experimental research laboratory. INTERVENTIONS: Anesthetized, normoventilated, normovolemic domestic pigs were randomized to ischemia ( n=7) and sham groups ( n=7). SMA blood flow was reduced stepwise at 15-min intervals by 22%, 44%, 66%, and 88% and kept constant thereafter for 60 min. MEASUREMENTS AND RESULTS: Jejunal luminal microdialysate lactate and mucosal pCO(2) were measured every 15 min. The luminal lactate increased over the upper normal limit of 0.2 mmol/l at a median SMA blood flow of 9.6 ml kg(-1) min(-1) (range 7.5-23.7). In five of seven animals the increase in luminal lactate was preceded by or accompanied by an increase in the mucosal-arterial pCO(2) gradient. CONCLUSIONS: There is a threshold of SMA blood flow below which gut luminal lactate increases, indicating mucosal anaerobic metabolism. Measurement of gut luminal lactate by microdialysis can be used to assess the adequacy of gut perfusion and the onset of anaerobic metabolism.
OBJECTIVES: Gut ischemia induced by occlusion of the superior mesenteric artery (SMA) results in release of lactate into the gut lumen. We studied the threshold of SMA flow reduction that leads to increased gut luminal lactate during stepwise reduction in SMA blood flow. DESIGN AND SETTING: A randomized, controlled animal experiment in a university experimental research laboratory. INTERVENTIONS: Anesthetized, normoventilated, normovolemic domestic pigs were randomized to ischemia ( n=7) and sham groups ( n=7). SMA blood flow was reduced stepwise at 15-min intervals by 22%, 44%, 66%, and 88% and kept constant thereafter for 60 min. MEASUREMENTS AND RESULTS: Jejunal luminal microdialysate lactate and mucosal pCO(2) were measured every 15 min. The luminal lactate increased over the upper normal limit of 0.2 mmol/l at a median SMA blood flow of 9.6 ml kg(-1) min(-1) (range 7.5-23.7). In five of seven animals the increase in luminal lactate was preceded by or accompanied by an increase in the mucosal-arterial pCO(2) gradient. CONCLUSIONS: There is a threshold of SMA blood flow below which gut luminal lactate increases, indicating mucosal anaerobic metabolism. Measurement of gut luminal lactate by microdialysis can be used to assess the adequacy of gut perfusion and the onset of anaerobic metabolism.
Authors: Brian S Ferguson; Matthew J Rogatzki; Matthew L Goodwin; Daniel A Kane; Zachary Rightmire; L Bruce Gladden Journal: Eur J Appl Physiol Date: 2018-01-10 Impact factor: 3.078
Authors: Upendra R Gumaste; Mukund M Joshi; Devendra T Mourya; Pradip V Barde; Ghanshyam K Shrivastav; Vikram S Ghole Journal: World J Gastroenterol Date: 2005-02-14 Impact factor: 5.742
Authors: Erik Solligård; Ingebjørg S Juel; Karin Bakkelund; Harald Johnsen; Ola D Saether; Jon Erik Grønbech; Petter Aadahl Journal: Intensive Care Med Date: 2004-02-28 Impact factor: 17.440
Authors: Brian Glancy; Daniel A Kane; Andreas N Kavazis; Matthew L Goodwin; Wayne T Willis; L Bruce Gladden Journal: J Physiol Date: 2020-05-27 Impact factor: 6.228
Authors: Lauri Pynnönen; Minna Minkkinen; Anders Perner; Sari Räty; Isto Nordback; Juhani Sand; Jyrki Tenhunen Journal: BMC Gastroenterol Date: 2013-12-10 Impact factor: 3.067
Authors: Runar J Strand-Amundsen; Henrik M Reims; Finn P Reinholt; Tom E Ruud; Runkuan Yang; Jan O Høgetveit; Tor I Tønnessen Journal: World J Gastroenterol Date: 2018-05-14 Impact factor: 5.742