Aortic Cross-Clamping and Reperfusion in Pigs Reduces Microvascular Oxygenation by Altered Systemic and Regional Blood Flow Distribution

Siegemund, Martin; Bommel, Jasper van; Stegenga, Michiel E.; Studer, Wolfgang; Iterson, Mat van; Annaheim, Sandra; Mebazaa, Alexandre; İnce, Can

doi:10.1213/ane.0b013e3181e4255f

Cited by 28 publications

(34 citation statements)

References 29 publications

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“…Using LSCI for microcirculatory blood flow evaluation of the terminal ileum together with macrohaemodynamic measurements, impairment of intestinal microcirculation was observed accompanied by a decline in MAP, SV, and CO 6 h after I/R. This microcirculatory behavior is in line with the results of Siegemund et al, 25 who showed a reduction of serosal microcirculatory oxygenation and perfused ileal capillaries 3 h after I/R and has been reported for other organs as well. 18,26 Simultaneous examination of macrohaemodynamic parameters and intestinal microcirculation during volume administration shows dissociation between micro-and macrocirculatory blood flow.…”

Section: Color-picturesupporting

confidence: 87%

Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs

Behem

Graessler

Pinnschmidt

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS The study provides further insight into the behaviour of intestinal microcirculatory blood flow after ischaemia/ reperfusion injury. The results of the study emphasise that volume therapy should be titrated with meticulous care, particularly after ischaemia/reperfusion injury, and that unnecessary fluid load may impair microcirculatory flow and worsen tissue oedema. Effects on tissue oxygen supply, tissue viability, and patient outcome should be addressed in further studies.Objectives: In the presence of ischaemia/reperfusion (I/R) induced endothelial injury, volume administration may not correlate with increased microcirculation. The aim of this study was to evaluate intestinal microcirculation after standardised sequential volume loading in an animal model of I/R injury following supracoeliac aortic clamping.Methods: This was a prospective exploratory pilot animal study. Intestinal I/R injury was induced in eight pigs during experimental thoraco-abdominal aortic repair. After 6 h of I/R, microcirculatory blood flow (mFlux, measured in the ileum using direct laser speckle contrast imaging) and macrohaemodynamic parameters (using trans-cardiopulmonary thermodilution) were measured and measurements were repeated after each of four sequential volume loading steps (VLS1 e 4). Each load was administered over 5 min followed by another 5 min for equilibration. Results: All animals survived until after VLS4. After 6 h of I/R cardiac output (CO) (p < .001) and mFlux (p < .001) had both decreased. CO increased again after VLS1 (p < .001) and VLS2 (p ¼ .036), whereas mFlux did not change. In contrast, mFlux further decreased after VLS3 (p < .01) and VLS4 (p < .001), whereas CO did not change anymore. Extravascular lung water continued to increase after VLS2 (p ¼ .046) and VLS4 (p ¼ .049). Conclusions: I/R leads to impaired intestinal microcirculation, which was not restored by volume administration in spite of improved CO. In contrast, further volume administration exceeding preload reserves was associated with additional decreases in the intestinal microcirculation. The potentially negative effect of excessive volume resuscitation after I/R injury should encourage further translational research.

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Section: Color-picturesupporting

confidence: 87%

Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs

Behem

Graessler

Pinnschmidt

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…Kidney tissue P o 2 has been directly quantified in animal models of AKI induced by radiocontrast administration, renal ischaemia–reperfusion, endotoxaemia and rhabdomyolysis . These studies confirm that the tissue is hypoxic, although studies using less direct methods, such as blood oxygen‐dependent magnetic resonance imaging (BOLD MRI), have not always confirmed the presence of hypoxia in some models .…”

Section: Haemodynamic Factors and Renal Hypoxia In Acute Kidney Injurmentioning

confidence: 99%

Haemodynamic influences on kidney oxygenation: Clinical implications of integrative physiology

Evans

İnce

Joles

et al. 2013

Clin Exp Pharma Physio

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222

239

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SUMMARY1. Renal blood flow, local tissue perfusion and blood oxygen content are the major determinants of oxygen delivery to kidney tissue. Arterial pressure and segmental vascular resistance influence kidney oxygen consumption through effects on glomerular filtration rate and sodium reabsorption.2. Diffusive shunting of oxygen from arteries to veins in the cortex and from descending to ascending vasa recta in the medulla limits oxygen delivery to renal tissue. Oxygen shunting depends on the vascular network, renal haemodynamics and kidney oxygen consumption. Consequently, the impact of changes in renal haemodynamics on tissue oxygenation cannot necessarily be predicted intuitively and, instead, requires the integrative approach offered by computational modelling and multiple measuring modalities.3. Tissue hypoxia is a hallmark of acute kidney injury (AKI) arising from multiple initiating insults, including ischaemia-reperfusion injury, radiocontrast administration, cardiopulmonary bypass surgery, shock and sepsis. Its pathophysiology is defined by inflammation and/or ischaemia resulting in alterations in renal tissue oxygenation, nitric oxide bioavailability and oxygen radical homeostasis. This sequence of events appears to cause renal microcirculatory dysfunction, which may then be exacerbated by the inappropriate use of therapies common in peri-operative medicine, such as fluid resuscitation.4. The development of new ways to prevent and treat AKI requires an integrative approach that considers not just the molecular mechanisms underlying failure of filtration and tissue damage, but also the contribution of haemodynamic factors that determine kidney oxygenation. The development of bedside monitors allowing continuous surveillance of renal haemodynamics, oxygenation and function should facilitate better prevention, detection and treatment of AKI.

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“…In rats with 30 minutes of ischemia, RBF and cortical and medullary oxygenation were persistently reduced at 3 hours after reperfusion [22]. Similarly, in pigs with 45 minutes of aortic cross-clamping, reduced oxygenation and persistent hypoxia at 4 hours of reperfusion was observed [23]. Using MRI in rats before and after 45 minutes of ischemia followed by reperfusion for approximately 100 minutes, global reduction in tissue oxygenation during ischemia was observed [24].…”

Section: Ischemia-reperfusionmentioning

confidence: 99%

Renal Oxygenation and Hemodynamics in Kidney Injury

Bullen

Liu

Hepokoski

et al. 2017

Nephron

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Acute kidney injury (AKI) continues to be a major therapeutic challenge. Despite significant advances made in cellular and molecular pathophysiology of AKI, major gaps in knowledge exist regarding the changes in renal hemodynamics and oxygenation in the early stages and through the continuum of AKI. Particular features of renal hemodynamics and oxygenation increase the susceptibility of the kidney to sustain injury due to oxygen demand-supply mismatch and also play an important role in the recovery and repair from AKI as well as the transition of AKI to chronic kidney disease. However, lack of well-established physiological biomarkers and noninvasive imaging techniques limit our understanding of the interactions between renal macro and microcirculation and tissue oxygenation in AKI. Advances in our ability to assess these parameters in preclinical and clinical AKI will enable the development of targeted therapeutics to improve clinical outcomes.

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Aortic Cross-Clamping and Reperfusion in Pigs Reduces Microvascular Oxygenation by Altered Systemic and Regional Blood Flow Distribution

Abstract: Increased systemic and regional blood flow and oxygen supply after ACC does not ensure adequate regional blood flow and microcirculatory oxygenation in all organs.

Cited by 28 publications

References 29 publications

Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs

Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs

Haemodynamic influences on kidney oxygenation: Clinical implications of integrative physiology

Renal Oxygenation and Hemodynamics in Kidney Injury

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