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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2011 Luglio;77(7):698-703
Rectal microcirculatory alterations after elective on-pump cardiac surgery
Boerma E. C. 1,2, Kaiferová K. 2,3, Konijn A. J. M. 2,3, De Vries J. W. 4, Buter H. 2, Ince C. 1 ✉
1 Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;
2 Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands;
3 Department of Anaesthesiology, University Medical Center Groningen, Groningen, the Netherlands;
4 Department of Cardiothoracic Anaesthesiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
BACKGROUND: Hemodynamic changes, related to on-pump cardiac surgery, have been reported to impair intestinal perfusion. However, until recently, direct in vivo observation of the intestinal microcirculation was not clinically feasible, and the concept of altered intestinal blood flow in the setting of cardiac surgery depended on indirect observations from other techniques, such as tonometry and microdialysis. To establish the incidence of intestinal microvascular alterations after cardiac surgery, we performed direct in vivo observation of the microcirculation in a clinically accessible part of the intestinal tract in this setting.
METHODS: A single-center prospective observational study was conducted in postoperative elective on-pump cardiac surgery patients. Simultaneously, sidestream dark field (SDF) imaging and automated gas tonometry were performed in the rectal pouch within 30 minutes after ICU admission.
RESULTS: The rectal median microvascular flow index was 3(3-3) and the proportion of perfused vessels (PPV) was 85% (72-93). The median rectal-to-arterial partial carbon dioxide pressure difference (ΔPCO2) was 1.5 (-1.5-8.3) mmHg; 6 (21%) patients had a ΔPCO2> 8.3 mmHg, among them 2 (7%) with values> 10.5 mmHg.
CONCLSION:After elective on-pump cardiac surgery, direct in vivo observation of rectal mucosa revealed a PPV <90% in 54% of all patients. At the same time, rectal microcirculatory blood flow appeared to be unaltered. Combining rectal SDF imaging with rectal tonometry revealed a 7% incidence of rectal-to-arterial pCO2 gap >1.4,kPa, suggesting non-dysoxic perfusion in the majority of patients, despite the observed percentage of non-perfused crypts.