Gut luminal microdialysis of glycerol as a marker of intestinal ischemic injury and recovery

Solligård, Erik; Juel, Ingebjørg S.; Bakkelund, Karin E.; Jynge, Per; Tvedt, Kåre E.; Johnsen, Harald; Aadahl, Petter; Grönbech, Jon Erik

doi:10.1097/01.ccm.0000178187.84732.6c

Cited by 43 publications

(37 citation statements)

References 29 publications

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“…Intraluminal glycerol is a marker of intestinal injury. When possible, the gut lumen is to be preferred as a site for placement of microdialysis catheters [17]. As the colon is at risk, following both aortic surgery [18] and cardiac surgery [19], and in experimental septic shock [20], microdialysis probes placed in the rectum may be a potential minimally invasive tool for the detection of increased levels of lactate and glycerol in the gut lumen.…”

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confidence: 99%

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

et al. 2007

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SummaryThe aim of this prospective study was to determine the feasibility of intestinal endoluminal microdialysis as a new method for clinical monitoring of the adequacy of splanchnic perfusion in the large bowel. A microdialysis catheter for continuous lactate, glycerol, glucose and pyruvate measurements attached to a tonometric catheter was placed into the lumen of the recto-sigmoid junction prior to surgery in 13 patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Lactate was also measured in blood and muscle. CPB was associated with a 10-fold increase in luminal lactate from 0.16 (0.01) to 1.67 (0.38) mmol.l )1 (p < 0.001). Muscular lactate increased from baseline levels 1.20 (0.21) to 1.77 (0.36) mmol.l )1 during CPB (p = 0.01), but the muscular lactate-pyruvate ratio remained unchanged. Arterial lactate increased only slightly from 0.9 (0.05) to 1.1 (0.06) mmol.l )1 (p = 0.027) during CPB. Increased lactate concentrations in the large bowel during CPB are suggestive of local lactate production consistent with impaired oxygen delivery. Intestinal endoluminal microdialysis is a potential clinically applicable method for monitoring intestinal metabolism. Combined with tonometry, microdialysis provides the opportunity to monitor both circulation and metabolism in the rectal mucosa. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk of developing intestinal mucosal ischaemia, leading to disturbed mucosal integrity and increased intestinal permeability [1]. The latter may result in leakage of endotoxins into the circulation contributing to systemic inflammation observed during CPB [2]. The most likely cause of increased intestinal vascular permeability is imbalance between splanchnic oxygen supply and demand [3].There are currently few reliable methods available for monitoring adequacy of splanchnic perfusion during CPB. If available, these data could lead to strategies being developed to reduce intestinal ischaemia and the resulting increased mucosal permeability. Gastric tonometry is the only clinically available method that allows monitoring of gastro-intestinal perfusion. Even though in cardiac [4,5] and high-risk surgical patients [6] peri-operative tonometry-derived variables are predictive

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Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

et al. 2007

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“…Glycerol is a key component of cell membrane and, in anaerobic conditions, phospholipase and glycerol are released to extracellular interstitial space as a result of cell destruction. 11,12 Glucose metabolism in the intensive care setting is quite complex. The neuroendocrine and inflammatory response to stress leads to alterations in glucose metabolism.…”

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confidence: 99%

Intraperitoneal Microdialysis as a Monitoring Method in the Intensive Care Unit

Konstantinos

Komnos

Paraforos

et al. 2014

International Surgery

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Studies on surgical patients provide some evidence of prompt detection of enteric ischemia with microdialysis. The purpose of the study was to measure intraperitoneal microdialysis values (glucose, glycerol, pyruvate, and lactate) in patients hospitalized in an intensive care unit (ICU) with an underlying abdominal surgical condition and to correlate these values with patients' outcomes. Twenty-one patients, 10 female, were enrolled in the study. The intraperitoneal metabolite values were measured for 3 consecutive days, starting from the first day of ICU hospitalization. Descriptive and inferential statistics were performed. The t-test, repeated measures analysis, Holm's test, and a logistic regression model were applied. Level of statistical significance was set at P ¼ 0.05. Mean age of participants was 68.10 6 8.02 years old. Survivors exhibited statistically significantly higher glucose values on day 3 (6.61 6 2.01 against 3.67 6 1.62; P ¼ 0.002). Mean lactate/ pyruvate (L/P) values were above 20 (35.35 6 27.11). All nonsurvivors had a mean three day L/P values greater than 25.94. Low L/P values were related to increased survival possibilities. High microdialysis glucose concentration, high L/P ratio and low glucose concentration were the major findings during the first three ICU hospitalization days in non-survivors. Intraperitoneal microdialysis may serve as a useful tool in understanding enteric ischemia pathophysiology.

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“…Samples were collected over 30 min and were analyzed immediately on site for glycerol and lactate by enzymatic fluorometric assays (CMA 600 microdialysis analyzer) using peroxidise methodology. In vitro recovery at a flow rate of 1 l/min has been tested for three microdialysis catheters in 1.1-, 5.5-, and 10.3-m M concentrations of sodium lactate in Ringer's acetate (64 [7] %), and 100-, 500-, and 1,000-M concentrations of glycerol in Ringer's acetate (37 [4] %) [13] .…”

Section: Microdialysismentioning

confidence: 99%

“…The animals were deprived of food, but not water, for 24 h before the experiment. Anesthesia was induced and maintained as previously described in detail [13,21] . The animals were tracheotomized and mechanically ventilated with 40% oxygen at a rate of 20 breaths/min.…”

Section: Surgical Preparationmentioning

confidence: 99%

“…Such animals showed a sustained elevation of lactate and blood-to-lumen permeability of fluorescein isothiocyanate dextran after 2 h of partial strangulation, but a decline to baseline levels of these parameters in animals with 1 h partial strangulation. Conclusion: Microdialy-cently it was shown that microdialysis of glycerol derived from damaged cell membranes and released to the intestinal lumen can distinguish between histologic injury caused by different duration of complete intestinal ischemia in an experimental model [13] . However, this technique has not been evaluated either clinically, or in experimental models on strangulation obstruction of the intestine.…”

Section: Introductionmentioning

confidence: 99%

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Lactate and Glycerol Released to the Intestinal Lumen Reflect Mucosal Injury and Permeability Changes Caused by Strangulation Obstruction

Juel¹,

Solligård

Skogvoll

et al. 2007

Eur Surg Res

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Background: The present study evaluates whether microdialysis of glycerol and lactate reflects mucosal injury and permeability changes after strangulation obstruction of the pig small intestine. Methods: Strangulation obstruction was induced by tightening a rubber band around a small bowel loop until its venous pressure increased to a level just below diastolic aortic pressure (partial strangulation), or further until cessation of flow in the main feeding artery (total strangulation). Mucosal injury and permeability of marker molecules from blood to lumen and vice versa was compared to release of glycerol and lactate to the intestinal lumen. Results: Mucosal injury, hyperpermeability, and release of glycerol were more pronounced after total than after partial strangulation. In animals with partial strangulation there was a complete restitution of the surface epithelium, and luminal glycerol and lumen-to-blood permeability of polyethylene glycol 4000 remained low. Such animals showed a sustained elevation of lactate and blood-to-lumen permeability of fluorescein isothiocyanate dextran after 2 h of partial strangulation, but a decline to baseline levels of these parameters in animals with 1 h partial strangulation. Conclusion: Microdialysis of lactate and glycerol in the intestinal lumen may be used to assess structural and functional changes of the intestinal mucosa after strangulation obstruction.

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Gut luminal microdialysis of glycerol as a marker of intestinal ischemic injury and recovery

Abstract: Microdialysis of glycerol provides information about the extent and severity of intestinal damage after ischemia and about the ensuing recovery. The gut lumen is to be preferred as a site for placement of microdialysis catheters.

Cited by 43 publications

References 29 publications

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

Rectal lactate levels in endoluminal microdialysate during routine coronary surgery*

Intraperitoneal Microdialysis as a Monitoring Method in the Intensive Care Unit

Lactate and Glycerol Released to the Intestinal Lumen Reflect Mucosal Injury and Permeability Changes Caused by Strangulation Obstruction

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