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. Design: Single-arm prospective study. Setting: University hospital operating room and intensive care unit. Participants: Ten adult patients undergoing cardiac surgery. Interventions: SBF was measured using constant rate in fusion 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. Measurements and Main 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. Conclusion: SBT 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.

Nyckelord

cardiopulmonary bypass (CPB)

echocardiography

ethanol

indocyanine green (ICG)

splanchnic circulation

gastric intramucosal ph

low cardiac-output

right-ventricular function

transesophageal echocardiography

intramural ph

gastrointestinal complications

indocyanine green

duplex ultrasound

mucosal ph

surgery

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