Splanchnic Circulation and Intraabdominal Metabolism in Two Porcine Models of Low Cardiac Output

Seilitz, Jenny; Hörer, Tal M.; Skoog, Per; Sadeghi, Mitra; Jansson, Kjell; Axelsson, Birger; Nilsson, Kristofer F.

doi:10.1007/s12265-018-9845-6

Cited by 5 publications

(6 citation statements)

References 40 publications

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“…As a result of VO 2 becoming supply dependent the lactate production increases and veno-arterial CO 2 gradient widens, indicating onset of anaerobic metabolism. Thus, a decrease in systemic oxygen consumption can be used as an estimate of organ/whole body metabolism when maximal oxygen extraction is reached (24,(30)(31)(32). Persistent oxygen supply dependency results in tissue hypoxia.…”

Section: Discussionmentioning

confidence: 99%

End-tidal Carbon Dioxide as an Indicator of Partial REBOA and Distal Organ Metabolism in Normovolemia and Hemorrhagic Shock in Anesthetized Pigs

Sadeghi

Hurtsén²,

Tegenfalk

et al. 2021

Shock

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It is difficult to estimate the ischemic consequences when using partial resuscitative endovascular balloon occlusion of the aorta (REBOA). The aim was to investigate if end-tidal carbon dioxide (ETCO 2 ) is correlated to degree of aortic occlusion, measured as distal aortic blood flow, and distal organ metabolism, estimated as systemic oxygen consumption (VO 2 ), in a porcine model of normovolemia and hemorrhagic shock. Materials and methods: Nine anesthetized pigs (25-32 kg) were subjected to incremental steps of zone 1 aortic occlusion (reducing distal aortic blood flow by 33%, 66%, and 100%) during normovolemia and hemorrhagic grade IV shock. Hemodynamic and respiratory variables, and blood samples, were measured. Systemic VO 2 was correlated to ETCO 2 and measures of partial occlusion previously described. Results: Aortic occlusion gradually lowered distal blood flow and pressure, whereas ETCO 2 , VO 2 and carbon dioxide production decreased at 66% and 100% aortic occlusion. Aortic blood flow correlated significantly to ETCO 2 during both normovolemia and hemorrhage (R ¼ 0.84 and 0.83, respectively) and to femoral mean pressure (R ¼ 0.92 and 0.83, respectively). Systemic VO 2 correlated strongly to ETCO 2 during both normovolemia and hemorrhage (R ¼ 0.91 and 0.79, respectively), blood flow of the superior mesenteric artery (R ¼ 0.77 and 0.85, respectively) and abdominal aorta (R ¼ 0.78 and 0.78, respectively), but less to femoral blood pressure (R ¼ 0.71 and 0.54, respectively). Conclusion: ETCO 2 was correlated to distal aortic blood flow and VO 2 during incremental degrees of aortic occlusion thereby potentially reflecting the degree of aortic occlusion and the ischemic consequences of partial REBOA. Further studies of ETCO 2 , and potential confounders, in partial REBOA are needed before clinical use.

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Section: Discussionmentioning

confidence: 99%

End-tidal Carbon Dioxide as an Indicator of Partial REBOA and Distal Organ Metabolism in Normovolemia and Hemorrhagic Shock in Anesthetized Pigs

Sadeghi

Hurtsén²,

Tegenfalk

et al. 2021

Shock

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“…In this study, inflation of an inferior caval vein balloon was used to simulate acute, severe, cardiac dysfunction through a predominant decrease in preload. This model does not simulate cardiac dysfunction from the perspective of the heart but elicits many of the intestinal consequences of this state, including low CO and MAP, reduced blood flow in the SMA, as well as increased MVP indicating mesenteric venous stasis ( 14 ). This model is therefore reasonable for investigations of drug effects on the gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

“…However, in this study, the intention was to induce and maintain a predetermined level of CO, which was accomplished, to isolate peripheral vasoactive effects from inotropy. Based on our previous work using a protocol with down titration of CO, the level of reduction was set to 60% of the baseline value ( 14 ). Cardiac output was monitored by a semicontinuous method, and the basic physiology of the animals, e.g., oxygenation, body temperature, and fluid balance, was carefully kept constant in all groups.…”

Section: Discussionmentioning

confidence: 99%

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A Randomized Porcine Study in Low Cardiac Output of Vasoactive and Inotropic Drug Effects on the Gastrointestinal Tract

Seilitz

Grafver

Kiszakiewicz

et al. 2021

Shock

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Background: Splanchnic vasodilation by inodilators is an argument for their use in critical cardiac dysfunction. To isolate peripheral vasoactivity from inotropy, such drugs were investigated, and contrasted to vasopressors, in a fixed low cardiac output (CO) model resembling acute cardiac dysfunction effects on the gastrointestinal tract. We hypothesized that inodilators would vasodilate and preserve the aerobic metabolism in the splanchnic circulation in low CO. Methods: In anesthetized pigs, CO was lowered to 60% of baseline by partial inferior caval vein balloon inflation. The animals were randomized to placebo (n = 8), levosimendan (24 μg kg −1 bolus, 0.2 μg kg −1 min −1 , n = 7), milrinone (50 μg kg −1 bolus, 0.5 μg kg −1 min −1 , n = 7), vasopressin (0.001, 0.002 and 0.006 U kg −1 min −1 , 1 h each, n = 7) or norepinephrine (0.04, 0.12, and 0.36 μg kg −1 min −1 , 1 h each, n = 7). Hemodynamic variables including mesenteric blood flow were collected. Systemic, mixed-venous, mesenteric-venous, and intraperitoneal metabolites were analyzed. Results: Cardiac output was stable at 60% in all groups, which resulted in systemic hypotension, low superior mesenteric artery blood flow, lactic acidosis, and increased intraperitoneal concentrations of lactate. Levosimendan and milrinone did not change any circulatory variables, but levosimendan increased blood lactate concentrations. Vasopressin and norepinephrine increased systemic and mesenteric vascular resistances at the highest dose. Vasopressin increased mesenteric resistance more than systemic, and the intraperitoneal lactate concentration and lactate/pyruvate ratio. Conclusion: Splanchnic vasodilation by levosimendan and milrinone may be negligible in low CO, thus rejecting the hypothesis. High-dose vasopressors may have side effects in the splanchnic circulation.

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“…The care and anesthetic methods used in the pilot study have been described previously. 24 In short, the animals were sedated using intramuscular azaperone before being transported to the laboratory. In the laboratory, the animals were anesthetized with an intramuscular injection of zolazepam, tiletamine, azaperone, and atropine.…”

Section: Anesthesia Surgical Instrumentation and Measurementsmentioning

confidence: 99%

Novel Experimental Technique to Create Size-Controlled Retroperitoneal Bleeding in the Infrarenal Aorta of Anesthetized Pigs

Pirouzram

Hamam

Wallin

et al. 2021

Innovations�(Phila)

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Objective Rupture of abdominal aortic aneurysm (rAAA) with a contained retroperitoneal hematoma is potentially fatal. Physiological studies are difficult to perform in patients suffering from life-threatening conditions such as rAAA. A translational model of the condition is therefore needed. The aim was to develop and validate an endovascular animal model for retroperitoneal bleeding of the abdominal aorta with contained hematoma. Methods In anesthetized pigs, a puncture hole was made in the posterolateral portion of the infrarenal aorta by an Outback re-entry catheter device. The hole was gradually enlarged using angioplasty balloons to a specific diameter of either 4 mm ( n = 6), 6 mm ( n = 7), or 8 mm ( n = 6). Onset of bleeding was verified by angiography and macroscopically examined on completion of the experiments. Survival up to 180 min was the primary outcome. Hemodynamic and metabolic markers in arterial blood were secondary outcomes. Results Aortic injury with a contained retroperitoneal hematoma was achieved in all animals. Survival rate at 180 min after onset of bleeding was higher in the 4 mm group compared to the 6 mm ( P = 0.021) and 8 mm groups ( P = 0.002), but not when comparing the 6 mm and 8 mm groups. Systemic hypotension, arterial acidosis, and lactatemia were provoked in the 6 mm and 8 mm groups but not in the 4 mm group. Conclusions A porcine model for a controlled contained left posterolateral retroperitoneal bleeding was created using endovascular methods and validated. This model makes it possible to study the pathophysiology of a retroperitoneal hematoma.

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Splanchnic Circulation and Intraabdominal Metabolism in Two Porcine Models of Low Cardiac Output

Cited by 5 publications

References 40 publications

End-tidal Carbon Dioxide as an Indicator of Partial REBOA and Distal Organ Metabolism in Normovolemia and Hemorrhagic Shock in Anesthetized Pigs

End-tidal Carbon Dioxide as an Indicator of Partial REBOA and Distal Organ Metabolism in Normovolemia and Hemorrhagic Shock in Anesthetized Pigs

A Randomized Porcine Study in Low Cardiac Output of Vasoactive and Inotropic Drug Effects on the Gastrointestinal Tract

Novel Experimental Technique to Create Size-Controlled Retroperitoneal Bleeding in the Infrarenal Aorta of Anesthetized Pigs

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