Gut mucosal ischemia during normothermic cardiopulmonary bypass results from blood flow redistribution and increased oxygen demand

Weike Tao, Joseph B. Zwischenberger, Thuan T. Nguyen, Roger A. Vertrees, Laura B. McDaniel, Leta K. Nutt, David Herndon, George Kramer

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Impaired gut mucosal perfusion has been reported during cardiopulmonary bypass. To better define the adequacy of gut blood flow and oxygenation during cardiopulmonary bypass, we measured overall gut blood flow and ileal mucosal flow and their relationship to mucosal pH, mesenteric oxygen delivery and oxygen consumption in immature pigs (n = 8). Normothermic, noncrossclamped, right atrium-to-aorta cardiopulmonary bypass was maintained at 100 ml/kg per minute for 120 minutes. Animals were instrumented with an ultrasonic Doppler flow probe on the superior mesenteric artery, a mucosal laser Doppler flow probe in the ileum, and pH tonometers in the stomach, ileum, and rectum. Radioactive microspheres were injected before and at 5, 60, and 120 minutes of cardiopulmonary bypass for tissue blood flow measurements. Overall gut blood flow significantly increased during cardiopulmonary bypass as evidenced by increases in superior mesenteric arterial flow to 134.1% ± 8.0%, 137.1% ± 7.5%, 130.3% ± 11.2%, and 130.2% ± 12.7% of baseline values at 30, 60, 90, and 120 minutes of bypass, respectively. Conversely, ileal mucosal blood flow significantly decreased to 53.6% ± 6.4%, 49.5% ± 6.8%, 58.9% ± 11.6%, and 47.8% ± 10.0% of baseline values, respectively. Blood flow measured with microspheres was significantly increased to proximal portions of the gut, duodenum and jejunum, during cardiopulmonary bypass, whereas blood flow to distal portions, ileum and colon, was unchanged. Gut mucosal pH decreased progressively during cardiopulmonary bypass and paralleled the decrease in ileal mucosal blood flow. Mesenteric oxygen delivery decreased significantly from 67.0 ± 10.0 ml/min per square meter at baseline to 42.4 ± 4.6, 44.9 ± 3.5, 46.0 ± 3.6, and 42.9 ± 3.9 ml/min per square meter at 30, 60, 90, and 120 minutes of bypass. Despite the decrease in mesenteric oxygen delivery, mesenteric oxygen consumption increased progressively from 10.8 ± 1.4 ml/min per square meter at baseline to 13.4 ± 1.2, 15.9 ± 1.2, 16.7 ± 1.4, and 16.6 ± 1.54 ml/min per square meter, respectively. We conclude that gut mucosal ischemia during normothermic cardiopulmonary bypass results from a combination of redistribution of blood flow away from mucosa and an increased oxygen demand. (J THORAC CARDIOVASC SURG 1995;110:819-28).

Original languageEnglish (US)
Pages (from-to)819-828
Number of pages10
JournalThe Journal of Thoracic and Cardiovascular Surgery
Volume110
Issue number3
DOIs
StatePublished - 1995
Externally publishedYes

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Cardiopulmonary Bypass
Ischemia
Oxygen
Ileum
Microspheres
Oxygen Consumption
Superior Mesenteric Artery
Jejunum
Heart Atria
Duodenum
Rectum
Ultrasonics
Aorta
Stomach
Colon
Mucous Membrane
Lasers
Swine
Perfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Gut mucosal ischemia during normothermic cardiopulmonary bypass results from blood flow redistribution and increased oxygen demand. / Tao, Weike; Zwischenberger, Joseph B.; Nguyen, Thuan T.; Vertrees, Roger A.; McDaniel, Laura B.; Nutt, Leta K.; Herndon, David; Kramer, George.

In: The Journal of Thoracic and Cardiovascular Surgery, Vol. 110, No. 3, 1995, p. 819-828.

Research output: Contribution to journalArticle

Tao, Weike ; Zwischenberger, Joseph B. ; Nguyen, Thuan T. ; Vertrees, Roger A. ; McDaniel, Laura B. ; Nutt, Leta K. ; Herndon, David ; Kramer, George. / Gut mucosal ischemia during normothermic cardiopulmonary bypass results from blood flow redistribution and increased oxygen demand. In: The Journal of Thoracic and Cardiovascular Surgery. 1995 ; Vol. 110, No. 3. pp. 819-828.
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abstract = "Impaired gut mucosal perfusion has been reported during cardiopulmonary bypass. To better define the adequacy of gut blood flow and oxygenation during cardiopulmonary bypass, we measured overall gut blood flow and ileal mucosal flow and their relationship to mucosal pH, mesenteric oxygen delivery and oxygen consumption in immature pigs (n = 8). Normothermic, noncrossclamped, right atrium-to-aorta cardiopulmonary bypass was maintained at 100 ml/kg per minute for 120 minutes. Animals were instrumented with an ultrasonic Doppler flow probe on the superior mesenteric artery, a mucosal laser Doppler flow probe in the ileum, and pH tonometers in the stomach, ileum, and rectum. Radioactive microspheres were injected before and at 5, 60, and 120 minutes of cardiopulmonary bypass for tissue blood flow measurements. Overall gut blood flow significantly increased during cardiopulmonary bypass as evidenced by increases in superior mesenteric arterial flow to 134.1{\%} ± 8.0{\%}, 137.1{\%} ± 7.5{\%}, 130.3{\%} ± 11.2{\%}, and 130.2{\%} ± 12.7{\%} of baseline values at 30, 60, 90, and 120 minutes of bypass, respectively. Conversely, ileal mucosal blood flow significantly decreased to 53.6{\%} ± 6.4{\%}, 49.5{\%} ± 6.8{\%}, 58.9{\%} ± 11.6{\%}, and 47.8{\%} ± 10.0{\%} of baseline values, respectively. Blood flow measured with microspheres was significantly increased to proximal portions of the gut, duodenum and jejunum, during cardiopulmonary bypass, whereas blood flow to distal portions, ileum and colon, was unchanged. Gut mucosal pH decreased progressively during cardiopulmonary bypass and paralleled the decrease in ileal mucosal blood flow. Mesenteric oxygen delivery decreased significantly from 67.0 ± 10.0 ml/min per square meter at baseline to 42.4 ± 4.6, 44.9 ± 3.5, 46.0 ± 3.6, and 42.9 ± 3.9 ml/min per square meter at 30, 60, 90, and 120 minutes of bypass. Despite the decrease in mesenteric oxygen delivery, mesenteric oxygen consumption increased progressively from 10.8 ± 1.4 ml/min per square meter at baseline to 13.4 ± 1.2, 15.9 ± 1.2, 16.7 ± 1.4, and 16.6 ± 1.54 ml/min per square meter, respectively. We conclude that gut mucosal ischemia during normothermic cardiopulmonary bypass results from a combination of redistribution of blood flow away from mucosa and an increased oxygen demand. (J THORAC CARDIOVASC SURG 1995;110:819-28).",
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AU - Tao, Weike

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AU - Nguyen, Thuan T.

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AU - McDaniel, Laura B.

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N2 - Impaired gut mucosal perfusion has been reported during cardiopulmonary bypass. To better define the adequacy of gut blood flow and oxygenation during cardiopulmonary bypass, we measured overall gut blood flow and ileal mucosal flow and their relationship to mucosal pH, mesenteric oxygen delivery and oxygen consumption in immature pigs (n = 8). Normothermic, noncrossclamped, right atrium-to-aorta cardiopulmonary bypass was maintained at 100 ml/kg per minute for 120 minutes. Animals were instrumented with an ultrasonic Doppler flow probe on the superior mesenteric artery, a mucosal laser Doppler flow probe in the ileum, and pH tonometers in the stomach, ileum, and rectum. Radioactive microspheres were injected before and at 5, 60, and 120 minutes of cardiopulmonary bypass for tissue blood flow measurements. Overall gut blood flow significantly increased during cardiopulmonary bypass as evidenced by increases in superior mesenteric arterial flow to 134.1% ± 8.0%, 137.1% ± 7.5%, 130.3% ± 11.2%, and 130.2% ± 12.7% of baseline values at 30, 60, 90, and 120 minutes of bypass, respectively. Conversely, ileal mucosal blood flow significantly decreased to 53.6% ± 6.4%, 49.5% ± 6.8%, 58.9% ± 11.6%, and 47.8% ± 10.0% of baseline values, respectively. Blood flow measured with microspheres was significantly increased to proximal portions of the gut, duodenum and jejunum, during cardiopulmonary bypass, whereas blood flow to distal portions, ileum and colon, was unchanged. Gut mucosal pH decreased progressively during cardiopulmonary bypass and paralleled the decrease in ileal mucosal blood flow. Mesenteric oxygen delivery decreased significantly from 67.0 ± 10.0 ml/min per square meter at baseline to 42.4 ± 4.6, 44.9 ± 3.5, 46.0 ± 3.6, and 42.9 ± 3.9 ml/min per square meter at 30, 60, 90, and 120 minutes of bypass. Despite the decrease in mesenteric oxygen delivery, mesenteric oxygen consumption increased progressively from 10.8 ± 1.4 ml/min per square meter at baseline to 13.4 ± 1.2, 15.9 ± 1.2, 16.7 ± 1.4, and 16.6 ± 1.54 ml/min per square meter, respectively. We conclude that gut mucosal ischemia during normothermic cardiopulmonary bypass results from a combination of redistribution of blood flow away from mucosa and an increased oxygen demand. (J THORAC CARDIOVASC SURG 1995;110:819-28).

AB - Impaired gut mucosal perfusion has been reported during cardiopulmonary bypass. To better define the adequacy of gut blood flow and oxygenation during cardiopulmonary bypass, we measured overall gut blood flow and ileal mucosal flow and their relationship to mucosal pH, mesenteric oxygen delivery and oxygen consumption in immature pigs (n = 8). Normothermic, noncrossclamped, right atrium-to-aorta cardiopulmonary bypass was maintained at 100 ml/kg per minute for 120 minutes. Animals were instrumented with an ultrasonic Doppler flow probe on the superior mesenteric artery, a mucosal laser Doppler flow probe in the ileum, and pH tonometers in the stomach, ileum, and rectum. Radioactive microspheres were injected before and at 5, 60, and 120 minutes of cardiopulmonary bypass for tissue blood flow measurements. Overall gut blood flow significantly increased during cardiopulmonary bypass as evidenced by increases in superior mesenteric arterial flow to 134.1% ± 8.0%, 137.1% ± 7.5%, 130.3% ± 11.2%, and 130.2% ± 12.7% of baseline values at 30, 60, 90, and 120 minutes of bypass, respectively. Conversely, ileal mucosal blood flow significantly decreased to 53.6% ± 6.4%, 49.5% ± 6.8%, 58.9% ± 11.6%, and 47.8% ± 10.0% of baseline values, respectively. Blood flow measured with microspheres was significantly increased to proximal portions of the gut, duodenum and jejunum, during cardiopulmonary bypass, whereas blood flow to distal portions, ileum and colon, was unchanged. Gut mucosal pH decreased progressively during cardiopulmonary bypass and paralleled the decrease in ileal mucosal blood flow. Mesenteric oxygen delivery decreased significantly from 67.0 ± 10.0 ml/min per square meter at baseline to 42.4 ± 4.6, 44.9 ± 3.5, 46.0 ± 3.6, and 42.9 ± 3.9 ml/min per square meter at 30, 60, 90, and 120 minutes of bypass. Despite the decrease in mesenteric oxygen delivery, mesenteric oxygen consumption increased progressively from 10.8 ± 1.4 ml/min per square meter at baseline to 13.4 ± 1.2, 15.9 ± 1.2, 16.7 ± 1.4, and 16.6 ± 1.54 ml/min per square meter, respectively. We conclude that gut mucosal ischemia during normothermic cardiopulmonary bypass results from a combination of redistribution of blood flow away from mucosa and an increased oxygen demand. (J THORAC CARDIOVASC SURG 1995;110:819-28).

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