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Critical Care
Published in: Critical Care 5/2000

01-10-2000 | Review

Understanding gastrointestinal perfusion in critical care: so near, and yet so far

Authors: Gareth Ackland, Michael PW Grocott, Michael G Mythen

Published in: Critical Care | Issue 5/2000

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Abstract

An association between abnormal gastrointestinal perfusion and critical illness has been suggested for a number of years. Much of the data to support this idea comes from studies using gastric tonometry. Although an attractive technology, the interpretation of tonometry data is complex. Furthermore, current understanding of the physiology of gastrointestinal perfusion in health and disease is incomplete. This review considers critically the striking clinical data and basic physiological investigations that support a key role for gastrointestinal hypoperfusion in initiating and/or perpetuating critical disease.
Literature
1.
Fine J, Frank ED, Ravin HA: The bacterial factor in traumatic shock. N Engl J Med 1959, 260: 214-220.PubMed
2.
Schweinburg F, Fine J: Evidence for a lethal endotoxaemia as the fundamental feature of irreversibility in three types of traumatic shock. J Exp Med 1960, 112: 793-800.PubMedCentralPubMed
3.
Dantzker D: The gastrointestinal tract. The canary of the body? JAMA 1993, 270: 1247-1248. 10.1001/jama.270.10.1247PubMed
4.
Pastores SM, Katz DP, Kvetan V: Splanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome. Am J Gastroenterol 1996, 91: 1697-1710.PubMed
5.
Bennett-Guerrero E, Welsby I, Dunn TJ, Young LR, Wahl TA, Diers TL, Phillips-Bute BG, Newman MF, Mythen MG: The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery. Anesth Analg 1999, 89: 514-519.PubMed
6.
Mythen MG, Webb AR: Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 1995, 130: 423-429.PubMed
7.
Doglio GR, Pusajo JF, Egurrola MA, Bonfigli GC, Parra C, Vetere L, Hernandez MS, Fernandez S, Palizas F, Gutierrez G: Gastric mucosal pH as a prognostic index of mortality in critically ill patients. Crit Care Med 1991, 19: 1037-1041.PubMed
8.
Gutierrez G, Palizas F, Doglio G, Wainsztein N, Gallesio A, Pacin J, Dubin A, Schiavi E, Jorge M, Pusajo J, et al.: Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 1992, 339: 195-199. 10.1016/0140-6736(92)90002-KPubMed
9.
Fiddian-Green RG, McGough E, Pittenger G, Rothman E: Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology 1983, 85: 613-620.PubMed
10.
Marik PE: Gastric Intramucosal pH: a better predictor of multiorgan dysfunction syndrome and death than oxygen-derived variables in patients with sepsis. Chest 1993, 104: 225-229.PubMed
11.
Maynard N, Bihari D, Beale R, Smithies M, Baldock G, Mason R, McColl I: Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA 1993, 270: 1203-1210. 10.1001/jama.270.10.1203PubMed
12.
Uusaro A, Ruokonen E, Takala J: Estimation of splanchnic blood flow by the Fick principle in man and problems in the use of indocyanine green. Cardiovasc Res 1995, 30: 106-112. 10.1016/0008-6363(95)00007-0PubMed
13.
Landow L, Phillips DA, Heard SO, Prevost D, Vandersalm TJ, Fink MP: Gastric tonometry and venous oximetry in cardiac surgery patients. Crit Care Med 1991, 19: 1226-1233.PubMed
14.
Ahn H, Ivarsson LE, Johansson K, Lindhagen J, Lundgren O: Assessment of gastric blood flow with laser Doppler flowmetry. Scand J Gastroenterol 1988, 23: 1203-1210.PubMed
15.
Leung FW, Morishita T, Livingston EH, Reedy T, Guth PH: Reflectance spectrophotometry for the assessment of gastroduodenal mucosal perfusion. Am J Physiol 1987, 252: G797-G804.PubMed
16.
Larsen PN, Moesgaard F, Naver L, Rosenberg J, Gottrup F, Kirkegaard P, Helledie N: Gastric and colonic oxygen tension measured with a vacuum-fixed oxygen electrode. Scand J Gastroenterol 1991, 26: 409-418.PubMed
17.
DeNobile J, Guzzetta P, Patterson K: Pulse oximetry as a means of assessing bowel viability. J Surg Res 1990, 48: 21-23. 10.1016/0022-4804(90)90139-SPubMed
18.
Glenny RW, Bernard S, Brinkley M: Validation of fluorescent-labeled microspheres for measurement of regional organ perfusion. J Appl Physiol 1993, 74: 2585-2597.PubMed
19.
Larson MV, Ahlquist DA, Karlstrom L, Sarr MG: Intraluminal measurement of enteric mucosal perfusion: relationship to superior mesenteric artery flow during basal and postprandial states in the dog. Surgery 1994, 115: 118-126.PubMed
20.
Chapman MV, Woolf RL, Mythen MG: Temperature dependant errors using gastrointestinal tonometry: an in vivo study [abstract 580]. Br J Anaesth 1999, 82: 174.
21.
Jakob SM, Kosonen P, Ruokonen E, Parviainen I, Takala J.: The Haldane effect: an alternative explanation for increasing gastric mucosal PCO2 gradients? Br J Anaesth 1999, 83: 740-746.PubMed
22.
Noone RB Jr, Mythen MG, Vaslef SN: Effect of alpha(alpha)-cross-linked hemoglobin and pyridoxalated hemoglobin polyoxyethylene conjugate solutions on gastrointestinal regional perfusion in hemorrhagic shock. J Trauma Injury Infect Crit Care 1998, 45: 457-469. 10.1097/00005373-199809000-00006
23.
Chapman MV, Mythen MG, Webb AR, Vincent JL: Gastrointestinal tonometry: state of the art. Intensive Care Med 2000, 26: 613-622. 10.1007/s001340051212PubMed
24.
Ohri SK, Bowles CT, Siddiqui A, Khaghani A, Keogh BE, Wright G, Yacoub MH, Taylor KM: The effect of cardiopulmonary bypass on gastric and colonic mucosal perfusion: a tonometric assessment. Perfusion 1994, 9: 101-108.PubMed
25.
Guzman JA, Lacoma FJ, Kruse JA: Gastric and esophageal intramucosal PCO2 (PiCO2) during endotoxemia: assessment of raw PiCO2 and PCO2 gradients as indicators of hypoperfusion in a canine model of septic shock. Chest 1998, 113: 1078-1083.PubMed
26.
Weil MH, Nakagawa Y, Tang W, Sato Y, Ercoli F, Finegan R, et al.: Sublingual capnometry: a new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock. Crit Care Med 1999, 27: 1225-1229. 10.1097/00003246-199907000-00001PubMed
27.
Rowell LB, Detry JM, Blackmon JR, Wyss C: Importance of the splanchnic vascular bed in human blood pressure regulation. J Appl Physiol 1972, 32: 213-220.PubMed
28.
Richardson PD, Withrington PG: Physiological regulation of the hepatic circulation. Annu Rev Physiol 1982, 44: 57-69. 10.1146/annurev.ph.44.030182.000421PubMed
29.
McCuskey RS: Hepatic and splanchnic microvascular responses to inflammation and shock. Hepatogastroenterology 1999, 46 (Suppl 2): 1464-1467.
30.
Bender A: The effect of increasing age on the distribution of peripheral blood flow in man. J Am Geriatr Soc 1965, 13: 61-65.
31.
Rosenblum JD, Boyle CM, Schwartz LB: The mesenteric circulation. Anatomy and physiology. Surg Clin North Am 1997, 77: 289-306.PubMed
32.
Folkow B: Regional adjustments of intestinal blood flow. Gastroenterology 1967, 52: 423-432.PubMed
33.
Granger DN, Richardson PD, Kvietys PR, Mortillaro NA: Intestinal blood flow. Gastroenterology 1980, 78: 837-863.PubMed
34.
Ralevic V: Splanchnic circulatory physiology. Hepatogastroenterology 1999, 46(Suppl 2): 1409-1413.
35.
Von Kugelgen I, Starke K: Noradrenaline and adenosine triphosphate as co-transmitters of neurogenic vasoconstriction in rabbit mesenteric artery. J Physiol 1985, 367: 435-455.PubMedCentralPubMed
36.
Donoso MV, Brown N, Carrasco C, Cortes V, Fournier A, Huidobro-Toro JP: Stimulation of the sympathetic perimesenteric arterial nerves releases neuropeptide Y potentiating the vasomotor activity of noradrenaline: involvement of neuropeptide Y-Y1 receptors. J Neurochem 1997, 69: 1048-1059.PubMed
37.
Han S, Yang CL, Chen X, Naes L, Cox BF, Westfall T: Direct evidence for the role of neuropeptide Y in sympathetic nerve stimulation-induced vasoconstriction. Am J Physiol 1998, 274: H290-H294.PubMed
38.
Kawasaki H, Takasaki K, Saito A, Goto K: Calcitonin gene-related peptide acts a novel vasodilator transmitter in mesenteric resistance vessels of the rat. Nature 1988, 335: 164-167. 10.1038/335164a0PubMed
39.
Bredt DS, Hwang PM, Snyder SH: Localization of nitric oxide synthase indicating a neural role for nitric oxide. Nature 1990, 347: 768-770. 10.1038/347768a0PubMed
40.
Ahlborg G, Lundberg JM: Nitric oxide-endothelin-1 interaction in humans. J Appl Physiol 1997, 82: 1593-1600.PubMed
41.
Boulanger C, Luscher TF: Release of endothelin from the porcine aorta: inhibition by endothlium-derived nitric oxide. J Clin Invest 1990, 85: 587-590.PubMedCentralPubMed
42.
Lerman A, Sandok EK, Hildebrand FL Jr, Burnett JC Jr: Inhibition of endothelium-derived relaxing factor enhances endothelin-mediated vasoconstriction. Circulation 1992, 85: 1894-1898.PubMed
43.
Haynes W, Webb DJ: Contribution of endogenous generation of endothelin-1 to basal vascular tone. Lancet 1994, 344: 852-854. 10.1016/S0140-6736(94)92827-4PubMed
44.
McMillen M, Sumpio BE: Endothelins: polyfunctional cytokines. J Am Coll Surg 1995, 180: 621-637.PubMed
45.
Gardiner SM, Kemp PA, March JE, Bennett T: Effects of bosentan (Ro 47-0203), an ETA-, ETB-receptor antagonist, on regional haemodynamic responses to endothelins in conscious rats. Br J Pharmacol 1994, 112: 823-830.PubMedCentralPubMed
46.
Richard VHM, Clozel M, Loffler B, Thuillez C: In vivo evidence of an endothelin-induced vasopressor tone after inhibition of nitric oxide synthesis in rats. Circulation 1995, 91: 771-775.PubMed
47.
Kubes P: Nitric oxide modulates epithlial permeability in the feline small intestine. Am J Physiol 1992, 262: G1138-G1142.PubMed
48.
Ahlborg G, Weitzberg E, Lundberg JM: Circulating endothelin-1 reduces splanchnic and renal blood flow and splanchnic glucose production in humans. J Appl Physiol 1995, 79: 141-145.PubMed
49.
Burnstock G, Ralevic V: New insights into the local regulation of blood flow by perivascular nerves and endothelium. Br J Plastic Surg 1994, 47: 527-543.
50.
Kawasaki H, Urabe M, Takasaki K: Presynaptic alpha 2-adrenoceptor modulation of 5-hydroxytryptamine and noradrenaline release from vascular adrenergic nerves. Eur J Pharmacol 1989, 164: 35-43.PubMed
51.
Rubino A, Ralevic V, Burnstock G: The P1-purinoceptors that mediate the prejunctional inhibitory effect of adenosine on capsaicin-sensitive nonadrenergic noncholinergic neurotransmission in the rat mesenteric arterial bed are of the A1 subtype. J Pharmacol Exp Ther 1993, 267: 1100-1104.PubMed
52.
Hamulu A, Atay Y, Yagdi T, Discigil B, Bakalim T, Buket S, Bilkay O: Effects of flow types in cardiopulmonary bypass on gastric intra-mucosal pH. Perfusion 1998, 13: 129-135.PubMed
53.
Lee J-S: Biomechanics of the circulation, an integrative and therapeutic perspective. Ann Biomed Eng 2000, 28: 1-13. 10.1114/1.249PubMed
54.
Reilly PM, Bulkley GB: Vasoactive mediators and splanchnic perfusion. Crit Care Med 1993, 21(2 Suppl): S55-S68.
55.
Lundgren O, Svanvik J: Mucosal hemodynamics in the small intestine of the cat during reduced perfusion pressure. Acta Physiol Scand 1973, 88: 551-563.PubMed
56.
Takala J: Determinants of splanchnic blood flow. Br J Anaesth 1996, 77: 50-58.PubMed
57.
Kvietys PR, Granger DN: Relation between intestinal blood flow and oxygen uptake. Am J Physiol 1982, 242: G202-G208.PubMed
58.
Granger HJ, Norris CP: Intrinsic regulation of intestinal oxygenation in the anesthetized dog. Am J Physiol 1980, 238: H836-H843.PubMed
59.
Bulkley GB, Womack WA, Downey JM, Kvietys PR, Granger DN: Characterization of segmental collateral blood flow in the small intestine. Am J Physiol 1985, 249: G228-G235.PubMed
60.
Granger HJ, Shepherd AP Jr: Intrinsic microvascular control of tissue oxygen delivery. Microvasc Res 1973, 5: 49-72.PubMed
61.
Bulkley GB, Kvietys PR, Parks DA, Perry MA, Granger DN: Relationship of blood flow and oxygen consumption to ischemic injury in the canine small intestine. Gastroenterology 1985, 89: 852-857.PubMed
62.
Guzman JA, Lacoma FJ, Kruse JA: Relationship between systemic oxygen supply dependency and gastric intramucosal PCO2 during progressive hemorrhage. J Trauma 1998, 44: 696-700.PubMed
63.
Hamilton-Davies C, Mythen MG, Salmon JB, Jacobson D, Shukla A, Webb AR: Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intensive Care Med 1997, 23: 276-281. 10.1007/s001340050328PubMed
64.
Bacher A, Mayer N, Rajek AM, Haider W: Acute normovolaemic haemodilution does not aggravate gastric mucosal acidosis during cardiac surgery. Intensive Care Med 1998, 24: 313-321. 10.1007/s001340050573PubMed
65.
Lipsitz LA, Ryan SM, Parker JA, Freeman R, Wei JY, Goldberger AL: Hemodynamic and autonomic nervous system responses to mixed meal ingestion in healthy young and old subjects and dysautonomic patients with postprandial hypotension. Circulation 1993, 87: 391-400.PubMed
66.
Kooner JS, Raimbach S, Watson L, Bannister R, Peart S, Mathias CJ: Relationship between splanchnic vasodilation and postprandial hypotension in patients with primary autonomic failure. J Hypertens 1989, 7(Suppl): S40-S41.
67.
Parker DR, Carlisle K, Cowan FJ, Corrall RJ, Read AE: Postprandial mesenteric blood flow in humans: relationship to endogenous gastrointestinal hormone secretion and energy content of food. Eur J Gastroenterol Hepatol 1995, 7: 435-440.PubMed
68.
Maule S, Chaudhuri KR, Thomaides T, Pavitt D, McCleery J, Mathias CJ: Effects of oral alcohol on superior mesenteric artery blood flow in normal man, horizontal and tilted. Clin Sci (Colch) 1993, 84: 419-425.
69.
Meehan AG, Kreulen DL: A capsaicin-sensitive inhibitory reflex from the colon to mesenteric arteries in the guinea-pig. J Physiol (Lond) 1992, 448: 153-159.
70.
Geelkerken RH, Lamers CB, Delahunt TA, Hermans J, Zwijsen JH, van Bockel JH: Duodenal meal stimulation leads to coeliac artery vasoconstriction and superior mesenteric artery vasodilatation: an intra-abdominal ultrasound study. Ultrasound Med Biol 1998, 24: 1351-1356. 10.1016/S0301-5629(98)00128-8PubMed
71.
Langkamp-Henken B, Kudsk KA, Proctor KG: Fasting-induced reduction of intestinal reperfusion injury. J Parent Ent Nutr 1995, 19: 127-132.
72.
Holst JJ, Fahrenkrug J, Stadil F, Rehfeld JF: Gastrointestinal endocrinology. Scand J Gastroenterol Suppl 1996, 216: 27-38.PubMed
73.
Mailman D: Effects of vasoactive intestinal polypeptide on intestinal absorption and blood flow. J Physiol (Lond) 1978, 279: 121-132.
74.
Schuurkes JA, Charbon GA: Motility and hemodynamics of the canine gastrointestinal tract. Stimulation by pentagastrin, cholecystokinin and vasopressin. Arch Int Pharmacodyn Ther 1978, 236: 214-227.PubMed
75.
Chou CC: Splanchnic and overall cardiovascular hemodynamics during eating and digestion. Fed Proc 1983, 42: 1658-1661.PubMed
76.
Kokko JP: Countercurrent exchanger in the small intestine of man: is there evidence for its existence? Gastroenterology 1978, 74: 791-793.PubMed
77.
Bustamante SA, Jodal M, Nilsson NJ, Lundgren O: Evidence for a countercurrent exchanger in the intestinal villi of suckling swine. Acta Physiol Scand 1989, 137: 207-213.PubMed
78.
Eade MN, Pybus J, Ready J: No evidence of a countercurrent multiplier in the intestinal villus of the dog. Gastroenterology 1990, 98: 3-10.PubMed
79.
Aranow JS, Fink MP: Determinants of intestinal barrier failure in critical illness. Br J Anaesth 1996, 77: 71-81.PubMed
80.
Lundgren O: Studies on blood flow distribution and countercurrent exchange in the small intestine. Acta Physiol Scand 1967, 303 (Suppl): 1-42.
81.
Shepherd AP, Kiel JW: A model of countercurrent shunting of oxygen in the intestinal villus. Am J Physiol 1992, 262: H1136-H1142.PubMed
82.
Kiel JW, Riedel GL, Shepherd AP: Effects of hemodilution on gastric and intestinal oxygenation. Am J Physiol 1989, 256: H171-H178.PubMed
83.
Jodal M, Lundgren O: Regional distribution of red cells, plasma and blood volume in the intestinal wall of the cat. Acta Physiol Scand 1970, 80: 533-537.PubMed
84.
Kolkman JJ, Groeneveld AB, van der Berg FG, Rauwerda JA, Meuwissen SG: Increased gastric PCO2 during exercise is indicative of gastric ischaemia: a tonometric study. Gut 1999, 44: 163-167.PubMedCentralPubMed
85.
Moore FA, Moore EE: The benefits of enteric feeding. Adv Surg 1996, 30: 141-154.PubMed
86.
87.
Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM: TEN versus TPN following major abdominal trauma: reduced septic morbidity. J Trauma Injury Infect Crit Care 1989, 29: 916-923.
88.
Lawlor DK, Inculet RI, Malthaner RA: Small-bowel necrosis associated with jejunal tube feeding. Can J Surg 1998, 41: 459-462.PubMedCentralPubMed
89.
Caru B, Colombo E, Santoro F, Laporta A, Maslowsky F: Regional flow responses to exercise. Chest 1992, 101(Suppl 5): 223S-225S.
90.
Perko MJ, Nielsen HB, Skak C, Clemmesen JO, Schroeder TV, Secher NH: Mesenteric, coeliac and splanchnic blood flow in humans during exercise. J Physiol (Lond) 1998, 513: 907-913.
91.
92.
Nielsen HB, Svendsen LB, Jensen TH, Secher NH: Exercise-induced gastric mucosal acidosis. Med Sci Sports Exerc 1995, 27: 1003-1006.PubMed
93.
Osada T, Katsumura T, Hamaoka T, Inoue S, Esaki K, Sakamoto A, Murase N, Kajiyama J, Shimomitsu T, Iwane H: Reduced blood flow in abdominal viscera measured by Doppler ultrasound during one-legged knee extension. J Appl Physiol 1999, 86: 709-719.PubMed
94.
Halvorsen FA, Ritland S: Gastrointestinal problems related to endurance event training. Sports Med 1992, 14: 157-163.PubMed
95.
Kinugawa T, Ogino K, Kitamura H, Miyakoda H, Saitoh M, Hasegawa J, Kotake H, Mashiba H: Response of sympathetic nervous system activity to exercise in patients with congestive heart failure. Eur J Clin Invest 1991, 21: 542-547.PubMed
96.
Stebbins CL, Symons JD: Role of angiotensin II in hemodynamic responses to dynamic exercise in miniswine. J Appl Physiol 1995, 78: 185-190.PubMed
97.
McAllister RM: Adaptations in control of blood flow with training: splanchnic and renal blood flows. Med Sci Sports Exerc 1998, 30: 375-381.PubMed
98.
Jansen RW, Lipsitz LA: Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med 1995, 122: 286-295.PubMed
99.
Oberman AS, Harada RK, Gagnon MM, Kiely DK, Lipsitz LA: Effects of postprandial walking exercise on meal-related hypotension in frail elderly patients [abstract 11]. Am J Cardiol 1999, 84: 1130-1132. 10.1016/S0002-9149(99)00520-2PubMed
100.
Chien S: Role of the sympathetic nervous system in hemorrhage. Physiol Rev 1967, 47: 214-288.PubMed
101.
Price HL, Deutsch S, Marshall BE, Stephen GW, Behar MG, Neufeld GR: Hemodynamic and metabolic effects of hemorrhage in man, with particular reference to the splanchnic circulation. Circ Res 1966, 18: 469-474.PubMed
102.
Vatner SF: Effects of hemorrhage on regional blood flow distribution in dogs and primates. J Clin Invest 1974, 54: 225-235.PubMedCentralPubMed
103.
Edouard AR, Degremont AC, Duranteau J, Pussard E, Berdeaux A, Samii K: Heterogeneous regional vascular responses to simulated transient hypovolemia in man. Intensive Care Med 1994, 20: 414-420.PubMed
104.
Mackway-Jones K, Foex BA, Kirkman E, Little RA: Modification of the cardiovascular response to hemorrhage by somatic afferent nerve stimulation with special reference to gut and skeletal muscle blood flow. J Trauma 1999, 47: 481-485.PubMed
105.
Overman R, Wang SC: The contributory role of the afferent nervous factor in experimental shock: sublethal hemorrhage and sciatic nerve stimulation. Am J Physiol 1947, 148: 289-295.PubMed
106.
Quest JA, Gebber GL: Modulation of baroreceptor reflexes by somatic afferent nerve stimulation. Am J Physiol 1972, 222: 1251-1259.PubMed
107.
Stevens RD, Van Gessel E, Flory N, Fournier R, Gamulin Z: Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology 2000, 93: 115-121. 10.1097/00000542-200007000-00021PubMed
108.
Christopherson R, Beattie C, Frank SM, Norris EJ, Meinert CL, Gottlieb SO, Yates H, Rock P, Parker SD, Perler BA, et al.: Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology 1993, 79: 422-434.PubMed
109.
Vaisanen O, Ruokonen E, Parviainen I, Bocek P, Takala J: Ranitidine or dobutamine alone or combined has no effect on gastric intra-mucosal-arterial PCO(2) difference after cardiac surgery. Intensive Care Med 2000, 26: 45-51.PubMed
110.
Meissner A, Weber TP, Van Aken H, Rolf N: Limited upper thoracic epidural block and splanchnic perfusion in dogs. Anesth Analg 1999, 89: 1378-1381.PubMed
111.
Hogan QH, Stekiel TA, Stadnicka A, Bosnjak ZJ, Kampine JP: Region of epidural blockade determines sympathetic and mesenteric capacitance effects in rabbits. Anesthesiology 1995, 83: 604-610. 10.1097/00000542-199509000-00020PubMed
112.
Toung T, Reilly PM, Fuh KC, Ferris R, Bulkley GB: Mesenteric vasoconstriction in response to hemorrhagic shock. Shock 2000, 13: 267-273.PubMed
113.
McNeill JR, Stark RD, Greenway CV: Intestinal vasoconstriction after hemorrhage: roles of vasopressin and angiotensin. Am J Physiol 1970, 219: 1342-1347.PubMed
114.
Adar R, Franklin A, Spark RF, Rosoff CB, Salzman EW: Effect of dehydration and cardiac tamponade on superior mesenteric artery flow: role of vasoactive substances. Surgery 1976, 79: 534-543.PubMed
115.
Bailey RW, Bulkley GB, Hamilton SR, Morris JB, Haglund UH: Protection of the small intestine from nonocclusive mesenteric ischemic injury due to cardiogenic shock. Am J Surg 1987, 153: 108-116. 10.1016/0002-9610(87)90210-8PubMed
116.
Suvannapura A, Levens NR: Local control of mesenteric blood flow by the renin-angiotensin system. Am J Physiol 1988, 255: G267-G274.PubMed
117.
Aneman A, Svensson M, Broome M, Biber B, Petterson A, Fandriks L: Specific angiotensin II receptor blockage improves intestinal perfusion during graded hypovolemia in pigs. Crit Care Med 2000, 28: 818-823. 10.1097/00003246-200003000-00034PubMed
118.
Bailey RW, Bulkley GB, Hamilton SR, Morris JB, Smith GW: Pathogenesis of nonocclusive ischemic colitis. Ann Surg 1986, 203: 590-599.PubMedCentralPubMed
119.
Gasic S, Heinz G, Kleinbloesem C, Korn A: Effects of ACE inhibition with cilazapril on splanchnic and systemic haemodynamics in man. Br J Clin Pharmacol 1989, 27(Suppl 2): 225S-234S.
120.
Parviainen I, Rantala A, Ruokonen E, Tenhunen J, Takala J: Angiotensin converting enzyme inhibition has no effect on blood pressure and splanchnic perfusion after cardiac surgery. J Crit Care 1998, 13: 73-80.PubMed
121.
Booker PD, Davis AJ, Franks R: Gut mucosal perfusion in infants undergoing cardiopulmonary bypass: effect of preoperative captopril. Br J Anaesth 1997, 79: 14-18.PubMed
122.
Kincaid EH, Miller PR, Meredith JW, Chang MC: Enalaprilat improves gut perfusion in critically injured patients. Shock 1998, 9: 79-83.PubMed
123.
Leier CV: Regional blood flow responses to vasodilators and inotropes in congestive heart failure. Am J Cardiol 1988, 62: 86E-93E.PubMed
124.
Hock CE, Su JY, Lefer AM: Role of AVP in maintenance of circulatory homeostasis during hemorrhagic shock. Am J Physiol 1984, 246: H174-H179.PubMed
125.
Korner PI, Oliver JR, Zhu JL, Gipps J, Hanneman F: Autonomic, hormonal, and local circulatory effects of hemorrhage in conscious rabbits. Am J Physiol 1990, 258: H229-H239.PubMed
126.
Sander Jensen K: Heart and endocrine changes during central hypovolemia in man. Dan Med Bull 1991, 38: 443-457.PubMed
127.
Wallace A, Layug B, Tateo I, Li J, Hollenberg M, Browner W, Miller D, Mangano DT, et al.: Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 1998, 88: 7-17. 10.1097/00000542-199801000-00005PubMed
128.
Peysner K, Forsling ML: Vasopressin release in response to hypovolaemia in the conscious rat and the effect of opioid and aminergic receptor antagonists. J Physiol Pharmacol 1991, 42: 317-326.PubMed
129.
McSPI-Europe Research Group: Perioperative sympatholysis. Beneficial effects of the alpha 2-adrenoceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. Anesthesiology 1997, 86: 346-363. 10.1097/00000542-199702000-00010
130.
Yokotani K, Osumi Y: Effects of DJ-7141, a new peripherally acting alpha-2 adrenoceptor agonist, on blood pressure and gastric acid output in rats: evidence for the heterogeneity of alpha-2 adrenoceptors in different organs. Jpn J Pharmacol 1987, 43: 415-422.PubMed
131.
Mathias CJ: Pharmacological manipulation of human gastrointestinal blood flow. Fundam Clin Pharmacol 1997, 11: 29-34.PubMed
132.
Biffl WL, Moore EE: Splanchnic ischaemia/reperfusion and multiple organ failure. Br J Anaesth 1996, 77: 59-70.PubMed
133.
Dahn MS, Lange P, Lobdell K, Hans B, Jacobs LA, Mitchell RA: Splanchnic and total body oxygen consumption differences in septic and injured patients. Surgery 1987, 101: 69-80.PubMed
134.
Wilmore DW, Goodwin CW, Aulick LH, Powanda MC, Mason AD Jr, Pruitt BA Jr: Effect of injury and infection on visceral metabolism and circulation. Ann Surg 1980, 192: 491-504.PubMedCentralPubMed
135.
Gump FE, Kinney JM, Price JB Jr: Energy metabolism in surgical patients: oxygen consumption and blood flow. J Surg Res 1970, 10: 613-627. 10.1016/0022-4804(70)90090-9PubMed
136.
Ruokonen E, Takala J, Kari A, Saxen H, Mertsola J, Hansen EJ: Regional blood flow and oxygen transport in septic shock. Crit Care Med 1993, 21: 1296-1303.PubMed
137.
Arvidsson D, Rasmussen I, Almqvist P, Niklasson F, Haglund U: Splanchnic oxygen consumption in septic and hemorrhagic shock. Surgery 1991, 109: 190-197.PubMed
138.
Fink MP: Adequacy of gut oxygenation in endotoxemia and sepsis. Crit Care Med 1993, 21(Suppl 2): S4-S8.
139.
Yang S, William G, Bland K, Chaudry IH, Wang P: Differential alterations in systemic and regional oxygen delivery and consumption during the early and late stages of sepsis. J Trauma 1999, 47: 706.PubMed
140.
Fink MP: Does tissue acidosis in sepsis indicate tissue hypoperfusion? Intensive Care Med 1996, 22: 1144-1146. 10.1007/s001340050229PubMed
141.
Fink M: Cytopathic hypoxia in sepsis. Acta Anaesthesiol Scand 1997, 110(Suppl): 87-95.
142.
VanderMeer TJ, Wang H, Fink MP: Endotoxemia causes ileal mucosal acidosis in the absence of mucosal hypoxia in a normodynamic porcine model of septic shock. Crit Care Med 1995, 23: 1217-1226. 10.1097/00003246-199507000-00011PubMed
143.
Wort S, Evans TW: The role of the endothelium in modulating vascular control in sepsis and related conditions. Br Med Bull 1999, 55: 30-48. 10.1258/0007142991902286PubMed
144.
Drazenovic R, Samsel RW, Wylam ME, Doerschuk CM, Schumacker PT: Regulation of perfused capillary density in canine intestinal mucosa during endotoxemia. J Appl Physiol 1992, 72: 259-265. 10.1063/1.352124PubMed
145.
Mayer K, Temmesfeld-Wollbruck B, Friedland A, Olschewski H, Reich M, Seeger W, Grimminger AF: Severe microcirculatory abnormalities elicited by E. coli hemolysin in the rabbit ileum mucosa. Am J Respir Crit Care Med 1999, 160: 1171-1178.PubMed
146.
Moncada S, Palmer RM, Higgs EA: Nitric oxide: physiology, pathophysiology and pharmacology. Pharmacol Rev 1991, 43: 109-142.PubMed
147.
Weitzberg E, Lundberg JM, Rudehill A: Elevated plasma levels of endothelin in patients with sepsis syndrome. Circ Shock 1991, 33: 222-227.PubMed
148.
Aneman A, Bengtsson J, Snygg J, Holm M, Pettersson A, Fandriks L: Differentiation of the peptidergic vasoregulatory response to standardized splanchnic hypoperfusion by acute hypovolaemia or sepsis in anaesthetized pigs. Acta Physiol Scand 1999, 166: 293-300. 10.1046/j.1365-201X.1999.00574.xPubMed
149.
Broner C, O'Doriso MS, Rosenberg RB, O'Doriso TM: Cyclic nucleotides and vasoactive intestinal peptide production in a rabbit model of Escherichia coli septicemia. Am J Med Sci 1995, 309: 267-277.PubMed
150.
Fink MP: Therapeutic options directed against platelet activating factor, eicosanoids and bradykinin in sepsis. J Antimicrob Chemother 1998, 41(Suppl A): 81-94. 10.1093/jac/41.suppl_1.81
151.
Wort SJ, Evans TW: The role of the endothelium in modulating vascular control in sepsis and related conditions. Br Med Bull 1999, 55: 30-48. 10.1258/0007142991902286PubMed
152.
Symeonides S, Balk RA: Nitric oxide in the pathogenesis of sepsis. Infect Dis Clin North Am 1999, 13: 449-463.PubMed
153.
Petros A, Lamb G, Leone A, Moncada S, Bennett D, Vallance P: Effects of a nitric oxide synthase inhibitor in humans with septic shock. Cardiovasc Res 1994, 28: 34-39.PubMed
154.
Boughton-Smith NK HI, Deakin AM, Whittle BJ, Moncada S: Protective effect of S-nitroso-N-acetyl-pencillamine in endotoxin-induced acute intestinal damage in the rat. Eur J Pharmacol 1990, 191: 485-488. 10.1016/0014-2999(90)94185-ZPubMed
155.
Allman K, Stoddart AP, Kennedy MM, Young JD: L-Arginine augments nitric oxide production and mesenteric blood flow in ovine endotoxemia. Am J Physiol 1996, 271: H1296-H1301.PubMed
156.
Laszlo F, Whittle BJR, Moncada S: Attenuation by nitrosothiol NO donors of acute intestinal microvascular dysfunction in the rat. Br J Pharmacol 1995, 115: 498-502.PubMedCentralPubMed
157.
Schumacker PT, Kazaglis J, Connolly HV, Samsel RW, O'Connor MF, Umans JG: Systemic and gut O2 extraction during endotoxemia: role of nitric oxide synthesis. Am J Respir Crit Care Med 1995, 151: 107-115.PubMed
158.
Spain D, Wilson MA, Bar-Natan MF, Garrison RN: Nitric oxide synthase inhibition aggravates intestinal microvascular vasoconstriction and hypoperfusion of bacteremia. J Trauma 1994, 36: 720-725.PubMed
159.
Laszlo F, Whittle BJR, Moncada S: Time-dependent enhancement or inhibition of endotoxin-induced vascular injury in rat intestine by nitric oxide synthase inhibitors. Br J Pharmacol 1994, 111: 1309-1315.PubMedCentralPubMed
160.
Liu S, Barnes PJ, Evans TW: Time course and cellular localization of lipopolysaccharide induced inducible nitric oxide synthase messenger RNA expression in the rat in vivo . Crit Care Med 1997, 25: 512-518. 10.1097/00003246-199703000-00022PubMed
161.
Lefer AM, Lefer DJ: Nitric oxide. II. Nitric oxide protects in intestinal inflammation. Am J Physiol 1999, 276: G572-G575.PubMed
162.
Tsuneyoshi I, Kanmura Y, Yoshimura N: Nitric oxide as a mediator of reduced arterial responsiveness in septic patients. Crit Care Med 1996, 24: 1083-1086. 10.1097/00003246-199606000-00033PubMed
163.
Pittet JF, Morel DR, Hemsen A, Gunning K, Lacroix JS, Suter PM, Lundberg JM: Elevated plasma endothelin-1 concentrations are associated with the severity of illness in patients with sepsis. Ann Surg 1991, 213: 261-264.PubMedCentralPubMed
164.
Oldner A, Wanecek M, Weitzberg E, Rundgren M, Alving K, Ullman J, Rudehill A: Angiotensin II receptor antagonism increases gut oxygen delivery but fails to improve intestinal mucosal acidosis in porcine endotoxin shock. Shock 1999, 11: 127-135.PubMed
165.
Gardiner SM, Kemp PA, March JE, Bennett T: Enhancement of the hypotensive and vasodilator effects of endotoxaemia in conscious rats by the endothelin antagonist, SB 209670. Br J Pharmacol 1995, 116: 1718-1719.PubMedCentralPubMed
166.
Ruetten H, Thiemermann C, Vane JR: Effects of the endothelin receptor antagonist, SB 209670, on circulatory failure and organ injury in endotoxic shock in the anaesthetized rat. Br J Pharmacol 1996, 118: 198-204.PubMedCentralPubMed
167.
Yoshida H, Nakamura M: Inhibition by angiotensin converting enzyme inhibitors of endothelin secretion from cultured human endothelial cells. Life Sci 1992, 50: L195-L200. 10.1016/0024-3205(92)90432-O
168.
Nakamura M, Funakoshi T, Yoshida H, Arakawa N, Suzuki T, Hiramori K: Endothelium-dependent vasodilation is augmented by angiotensin converting enzyme inhibitors in healthy volunteers. J Cardiovasc Pharmacol 1992, 20: 949-954.PubMed
169.
Garrard CS, Kontoyannis DA, Piepoli M: Spectral analysis of heart rate variability in the sepsis syndrome. Clin Auton Res 1993, 3: 5-13.PubMed
170.
Silva E, DeBacker D, Creteur J, Vincent JL: Effects of vasoactive drugs on gastric intramucosal pH. Crit Care Med 1998, 26: 1749-1758. 10.1097/00003246-199810000-00034PubMed
171.
Pargger H, Hampl KF, Christen P, Staender S, Scheidegger D: Gastric intramucosal pH-guided therapy of infrarenal abdominal aneurysms: is it beneficial? Intensive Care Med 1998, 24: 769-776. 10.1007/s001340050664PubMed
172.
Ivatury RR, Simon RJ, Islam S, Fueg A, Rohman M, Stahl WM: A prospective randomized study of end points of resuscitation after major trauma: global oxygen transport indices versus organ-specific gastric mucosal pH. J Am Coll Surg 1996, 183: 145-154.PubMed
173.
Gomersall CD, Joynt GM, Freebairn RC, Hung V, Buckley TA, Oh TE: Resuscitation of critically ill patients based on the results of gastric tonometry: a prospective, randomized, controlled trial. Crit Care Med 2000, 28: 607-614. 10.1097/00003246-200003000-00001PubMed
Metadata
Title
Understanding gastrointestinal perfusion in critical care: so near, and yet so far
Authors
Gareth Ackland
Michael PW Grocott
Michael G Mythen
Publication date
01-10-2000
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2000
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc709

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