The Pathogenesis of Nonocclusive Mesenteric Ischemia: Implications for Research and Clinical Practice

Al-Diery, Hussam; Phillips, Anthony; Evennett, Nicholas; Pandanaboyana, Sanjay; Gilham, Michael; Windsor, John A.

doi:10.1177/0885066618788827

Cited by 70 publications

(82 citation statements)

References 64 publications

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“…To further support the hypothesis, that capsules are capable of avoiding hypoxic tissue damage in severely anaemic animals, the organs most sensitive to hypoxic damage were analysed; namely the kidney with its oxygen-dependent proximal tubules and the intestine with its juxta-positioned mucosa and submucosa physiologically approaching critical oxygen levels 34 – 36 . To evaluate the oxygenation status of the kidney, renal peritubular fibroblasts that express the mRNA of hypoxia inducible factor (HIF)-target gene EPO were used as a sensitive detection system 37 – 39 .…”

Section: Discussionmentioning

confidence: 99%

Albumin-derived perfluorocarbon-based artificial oxygen carriers can avoid hypoxic tissue damage in massive hemodilution

Wrobeln

Jägers

Quinting

et al. 2020

Sci Rep

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Artificial blood for clinical use is not yet available therefore, we previously developed artificial oxygen carriers (capsules) and showed their functionality in vitro and biocompatibility in vivo. Herein, we assessed the functionality of the capsules in vivo in a normovolemic hemodilution rat-model. We stepwise exchanged the blood of male Wistar-rats with medium either in the presence of capsules (treatment) or in their absence (control). We investigated tissue hypoxia thoroughly through online biomonitoring, determination of enzyme activity and pancreatic hormones in plasma, histochemical and immunohistochemical staining of small intestine, heart, liver and spleen as well as in situ hybridization of kidneys. After hemodilution, treated animals show higher arterial blood pressure and have a stable body temperature. Additionally, they show a more stable pH, a higher oxygen partial pressure (pO 2), and a lower carbon dioxide partial pressure (pCO 2). Interestingly, blood-glucose-levels drop severely in treated animals, presumably due to glucose consumption. Creatine kinase values in these animals are increased and isoenzyme analysis indicates the spleen as origin. Moreover, the small intestine of treated animals show reduced hypoxic injury compared to controls and the kidneys have reduced expression of the hypoxia-inducible erythropoietin mRNA. In conclusion, our capsules can prevent hypoxic tissue damage. The results provide a proof of concept for capsules as adequate erythrocyte substitute. The need to develop synthetic products for blood replacement has become more and more important during the last decades. On the one hand, the demographic change leads to increasing requirements for blood, and on the other hand, simultaneously the willingness for blood donation declines 1. Blood with its various characteristics fulfils many functions, recent developments of synthetic blood substitutes focus on its most important function: the transport of physiological gases, in particular of oxygen. Additional key requirements for artificial blood substitutes are optimal size, sterility, biocompatibility, and the ability to be stored without loss of functionality. Moreover, artificial oxygen carriers (AOCs) should have a long intravascular circulation time and universal usage independent of the blood group characteristics 2,3. There are two main approaches to realize the transport of essential gases. The first is the use of the physiological oxygen carrier hemoglobin (hemoglobin-based artificial oxygen carriers, HBOCs); a concept realized e.g. in the prominent product hemopure, that gained pharmaceutical approval in South Africa and Mexico. Further HBOCs (e.g. sanguinate) are currently tested in clinical trials 4. So far, most of the products showed severe side effects so that the manufacturing had to be stopped 5. The second is the work with synthetic materials like perfluorocarbons [perfluorocarbon-based artificial oxygen carriers (PFOCs)]. Depending on the actual partial pressure, PFOCs are able to solve gases physically 6...

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Section: Discussionmentioning

confidence: 99%

Albumin-derived perfluorocarbon-based artificial oxygen carriers can avoid hypoxic tissue damage in massive hemodilution

Wrobeln

Jägers

Quinting

et al. 2020

Sci Rep

View full text Add to dashboard Cite

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“…Non-occlusive mesenteric ischemia (NOMI) is responsible for almost 20% of ABI cases [69] and is caused by nonocclusive reduction of arterial blood flow. Hemodynamic instability followed by mesenteric arterial vasoconstriction is the main cause [70], usually seen as a part of systemic hypotensive state associated with impaired sympathetic response in elderly or critically ill patients with concomitant multiorgan damage [71]. CT scan findings have significant overlap with other ABI entities or bowel disorders including infectious and inflammatory diseases of bowel, making the diagnosis even more challenging [72].…”

Section: Non-occlusivementioning

confidence: 99%

Many faces of acute bowel ischemia: overview of radiologic staging

et al. 2021

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Acute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.

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“…Intestinal ischemia (II) in critically ill patients is a life-threatening complication, leading to sepsis [1][2][3] caused by bacterial translocation [4][5][6] or direct fecal contamination of the peritoneal cavity. Congestive heart failure, diabetes mellitus, peripheral artery occlusive disease and age older than 60 years are recognized risk factors [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients

et al. 2021

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Background Intestinal ischemia is a common complication with obscure pathophysiology in critically ill patients. Since insufficient delivery of oxygen is discussed, we investigated the influence of oxygen delivery, hemoglobin, arterial oxygen saturation, cardiac index and the systemic vascular resistance index on the development of intestinal ischemia. Furthermore, we evaluated the predictive power of elevated lactate levels for the diagnosis of intestinal ischemia. Methods In a retrospective case-control study data (mean oxygen delivery, minimum oxygen delivery, systemic vascular resistance index) of critical ill patients from 02/2009–07/2017 were analyzed using a proportional hazard model. General model fit and linearity were tested by likelihood ratio tests. The components of oxygen delivery (hemoglobin, arterial oxygen saturation and cardiac index) were individually tested in models. Results 59 out of 874 patients developed intestinal ischemia. A mean oxygen delivery less than 250ml/min/m2 (LRT vs. null model: p = 0.018; LRT for non-linearity: p = 0.012) as well as a minimum oxygen delivery less than 400ml/min/m2 (LRT vs null model: p = 0.016; LRT for linearity: p = 0.019) were associated with increased risk of the development of intestinal ischemia. We found no significant influence of hemoglobin, arterial oxygen saturation, cardiac index or systemic vascular resistance index. Receiver operating characteristics analysis for elevated lactate levels, pH, CO2 and central venous saturation was poor with an area under the receiver operating characteristic of 0.5324, 0.52, 0.6017 and 0.6786. Conclusion There was a significant correlation for mean and minimum oxygen delivery with the incidence of intestinal ischemia for values below 250ml/min/m2 respectively 400ml/min/m2. Neither hemoglobin, arterial oxygen saturation, cardiac index, systemic vascular resistance index nor elevated lactate levels could be identified as individual risk factors.

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The Pathogenesis of Nonocclusive Mesenteric Ischemia: Implications for Research and Clinical Practice

Cited by 70 publications

References 64 publications

Albumin-derived perfluorocarbon-based artificial oxygen carriers can avoid hypoxic tissue damage in massive hemodilution

Albumin-derived perfluorocarbon-based artificial oxygen carriers can avoid hypoxic tissue damage in massive hemodilution

Many faces of acute bowel ischemia: overview of radiologic staging

Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients

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