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Journal of Artificial Organs
Published in: Journal of Artificial Organs 2/2020

01-06-2020 | Hypotension | Case Report

Changes in tissue oxygenation in response to sudden intradialytic hypotension

Authors: Taisuke Kitano, Kiyonori Ito, Susumu Ookawara, Mitsutoshi Shindo, Takayuki Uchida, Masaya Kofuji, Hideyuki Hayasaka, Haruhisa Miyazawa, Yuichiro Ueda, Keiji Hirai, Taro Hoshino, Yoshiyuki Morishita

Published in: Journal of Artificial Organs | Issue 2/2020

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Abstract

A 76-year-old woman on hemodialysis (HD) for diabetic nephropathy was admitted to our hospital with occasional intradialytic hypotension (IDH). We continuously monitored the regional oxygen saturation (rSO2) in the brain, liver, and lower limb muscle during HD. The time course of changes in rSO2 ratios in each region was evaluated throughout HD. The rSO2 ratio was defined as the ratio of rSO2 value at t (min) during HD to the rSO2 value before HD. During the early phase of HD, blood pressure (BP) gradually decreased and both hepatic and lower limb muscle rSO2 ratios decreased with changes in BP, whereas the cerebral rSO2 ratio was relatively maintained. At around 90 min after HD initiation, the BP decreased to 71/46 mmHg (mean BP, 54 mmHg) and the previously maintained cerebral rSO2 ratio also suddenly decreased. Soon after the onset of IDH, ultrafiltration was stopped, normal saline was infused, and intravenous noradrenaline infusion was started. After the BP recovered, cerebral and hepatic rSO2 ratios improved, but the lower limb muscle rSO2 ratio remained low. After restarting ultrafiltration, improvement in the lower limb muscle rSO2 ratio was delayed, although cerebral and hepatic oxygenation were maintained. This observation aids in our understanding of the effect of IDH on regional tissue oxygenation.
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Metadata
Title
Changes in tissue oxygenation in response to sudden intradialytic hypotension
Authors
Taisuke Kitano
Kiyonori Ito
Susumu Ookawara
Mitsutoshi Shindo
Takayuki Uchida
Masaya Kofuji
Hideyuki Hayasaka
Haruhisa Miyazawa
Yuichiro Ueda
Keiji Hirai
Taro Hoshino
Yoshiyuki Morishita
Publication date
01-06-2020
Publisher
Springer Japan
Published in
Journal of Artificial Organs / Issue 2/2020
Print ISSN: 1434-7229
Electronic ISSN: 1619-0904
DOI
https://doi.org/10.1007/s10047-019-01147-x

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