Tissue gas tensions and tissue metabolites for detection of organ hypoperfusion and ischemia

Wælgaard, Lars; Dahl, Benny; Kvarstein, Gunnvald; Tønnessen, Tor Inge

doi:10.1111/j.1399-6576.2011.02572.x

Cited by 22 publications

(24 citation statements)

References 50 publications

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“…The sensor is a 0.5 mm thick single-use device, which has been FDA approved for use in human brain in neurosurgery. The sensor has also been used in experimental studies to detect ischemia in the heart [40,42], liver [58,59] and intestine [60]. At the tip of the sensor three optical sensors and one thermocouple are included in a 4 cm long gas-permeable poly-ethylene membrane.…”

Section: The Fiberoptical Multiparameter Sensormentioning

confidence: 99%

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Hyler

Pischke

Halvorsen

et al. 2015

Journal of the American Society of Echocardiography

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The epicardially attached miniaturized ultrasound transducer allowed the precise detection of different levels of coronary flow reduction. The results also showed a quantitative and linear relationship among coronary flow, ischemia, and myocardial function. Thus, the ultrasound transducer has the potential to improve the monitoring of myocardial ischemia and to detect graft failure during and after heart surgery.

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Section: The Fiberoptical Multiparameter Sensormentioning

confidence: 99%

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Hyler

Pischke

Halvorsen

et al. 2015

Journal of the American Society of Echocardiography

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“…The most important value is the lactate/pyruvate (L/P) ratio in the extracellular fluid, which serves as a timely marker of emerging ischemia and allows for the monitoring of hemorrhagic shock [13,14]. An increase in the L/P ratio to > 25 indicates the onset of anaerobic metabolism [15]. The L/P ratio may be helpful in discriminating between different mechanisms of hyperlactatemia and to distinguish the anaerobic portion of lactate production.…”

Section: Introductionmentioning

confidence: 99%

Anaerobic metabolism associated with traumatic hemorrhagic shock monitored by microdialysis of muscle tissue is dependent on the levels of hemoglobin and central venous oxygen saturation: a prospective, observational study

Burša

Pleva

2014

Scand J Trauma Resusc Emerg Med

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BackgroundTraumatic hemorrhagic shock resulting in tissue hypoxia is a significant cause of morbidity and mortality in polytraumatized patients. Early identification of tissue hypoxia is possible with microdialysis. The aim of this study was to determine the correlation between a marker of tissue hypoxia (L/P; lactate to pyruvate ratio) and selected parameters of systemic oxygen delivery (Hb; hemoglobin) and oxygen extraction (ScvO2; central venous oxygen saturation). We also investigated the severity of tissue hypoxia over the course of care.MethodsAdult patients with traumatic hemorrhagic shock were enrolled in this prospective, observational study. Microdialysis of the peripheral muscle tissue was performed. Demographic data and timeline of care were collected. Tissue lactate, pyruvate, glycerol, glucose levels, hemoglobin, serum lactate and oxygen saturation of the central venous blood (ScvO2) levels were also measured.ResultsThe L/P ratio trend may react to changes in systemic hemoglobin levels with a delay of 7 to 10 hours, particularly when systemic hemoglobin levels are increased by transfusion. Decrease in tissue L/P ratio may react to increase in ScvO2 with a delay of up to 10 hours, and such a decrease may signify elimination of tissue hypoxia after transfusion. We also observed changes in the L/P trend in the 13 hours preceding a change in the hemoglobin level. Fluid administration, which is routinely used as a first-line treatment of hypovolemic shock, can cause hemodilution and decreased hemoglobin. When ScvO2 decreases, increase in L/P ratio may precede the ScvO2 trend by 10 or 11 hours. An increase in the L/P ratio is an early warning sign of insufficient tissue oxygenation and should lead to intensive observation of hemoglobin levels, ScvO2 and other hemodynamic parameters. Patients who were treated more rapidly had lower maximal L/P values and a lower degree of tissue ischemia.ConclusionThe L/P ratio is useful to identify tissue ischemia and can estimate the effectiveness of fluid resuscitation. An increase in the L/P ratio is an early warning sign of inadequate tissue oxygenation and should lead to more detailed hemodynamic and laboratory monitoring. This information cannot usually be obtained from global markers.

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“…Changes in L/P ratio may therefore accurately indicate a condition of tissue hypoxia and/or ischemia, and it is wide accepted that a ratio >25 indicates the onset of anaerobic metabolism (9, 14). Nevertheless, an increased L/P ratio in the presence of elevated pyruvate may be the consequence not only of decreased oxygen delivery (ischemic hypoxia) but also of mitochondrial dysfunction (9, 15). …”

Section: Discussionmentioning

confidence: 99%

Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock

Hajjej

Meddeb

Sellami

et al. 2017

Shock

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Introduction:Mitochondrial dysfunction and consequent cellular energetic failure play a key role in the development of sepsis-related organs failure. Evidence suggests that the pleiotropic effects of levosimendan may positively affect cellular metabolism during septic shock.Objectives:To investigate changes in the concentration of glucose, lactate, pyruvate, and glycerol in the extracellular fluid of the skeletal muscle following levosimendan administration in patients with septic shock.Methods:The study was designed as a prospective, double-blind, controlled, clinical pilot trial and performed in a multidisciplinary intensive care unit. After achieving normovolemia and a mean arterial pressure of at least 65 mm Hg, 20 septic shock patients were randomized to receive either levosimendan 0.2 μg/kg/min (n = 10), or dobutamine 5 μg/kg/min as active comparator (n = 10). Interstitial tissue concentrations of lactate, pyruvate, glucose, and glycerol were obtained by using muscle microdialysis. All measurements, including data from right heart catheterization, were obtained at baseline and every 6 h for the following 72 h after randomization.The trial is registered with Clinicaltrials.gov, number NCT02963454.Results:Compared with dobutamine, levosimendan increased interstitial tissue pyruvate concentration (153.3 ± 73 and 187. 2 ± 13.5 vs. 210.7 ± 76.2 and 161 ± 64.6; P < 0.05), and lactate clearance (55 vs. 10). Lactate/pyruvate ratio was lower in the levosimendan group at the end of study period (37. 7 ± 18.9 and 29.3 ± 12.7 vs. 10.9 ± 4.5 and 31.4 ± 13. 2; P < 0.05).Conclusion:Although we investigated a small number of patients, our preliminary results suggest that levosimendan may improve cellular metabolic alterations in patients with septic shock.

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Tissue gas tensions and tissue metabolites for detection of organ hypoperfusion and ischemia

Cited by 22 publications

References 50 publications

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Continuous Monitoring of Regional Function by a Miniaturized Ultrasound Transducer Allows Early Quantification of Low-Grade Myocardial Ischemia

Anaerobic metabolism associated with traumatic hemorrhagic shock monitored by microdialysis of muscle tissue is dependent on the levels of hemoglobin and central venous oxygen saturation: a prospective, observational study

Effects of Levosimendan on Cellular Metabolic Alterations in Patients With Septic Shock

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