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Volume 3 Supplement 1

ESICM LIVES 2015

Microcirculatory alterations are more severe in anemic than in ischemic hypoxia

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Introduction

The intestinal mucosal-arterial PCO2 (ΔPCO2) remains remarkably stable in anemic hypoxia suggesting that the villi perfusion is well-maintained1. The microcirculation, however, has been insufficiently studied in extreme hemodilution.

Objectives

To assess intestinal microcirculation during progressive hemorrhage and hemodilution.

Methods

Sheep were assigned to either stepwise bleeding (n = 8) or blood exchange with HES 130/0.4 (n = 8). A sham group (n = 8) was also studied. Oxygen transport and consumption were measured by expired gases analysis, microcirculation with SDF-technology, and ΔPCO2 by air capnometry.

Results

In the last step, there were similar reductions in systemic and intestinal oxygen transports and consumptions, and increases in respiratory quotient and lactate, in ischemic and anemic hypoxia compared to sham group. ΔPCO2 only increased in ischemic hypoxia (25 ± 10, 5 ± 6, and 5 ± 6 mm Hg, P < 0.01). Superior mesenteric artery blood flow decreased in ischemic hypoxia and increased in anemic hypoxia (138 ± 55, 524 ± 99, and 325 ± 112 mL/min, P < 0.0001), but mucosal and serosal microcirculations were more severely altered in anemic than in ischemic hypoxia.

Conclusions

Although intestinal serosal and mucosal microcirculations were severely compromised in anemic hypoxia, the ΔPCO2 did not increase. The lack of change in ΔPCO2 cannot be ascribed to the preservation of villi perfusion. These findings might be explained by blood flow redistribution toward submucosal and muscular layers.

Grant Acknowledgment

Supported by the grant PICT-2010-00495, Agencia Nacional de Promoción Científica y Tecnológica, Argentina.

Figure 2
figure1

Intestinal microcirculation.

References

  1. 1.

    Dubin A, Estenssoro E, Murias G, Pozo MO, Sottile JP, Barán M, Piacentini E, Canales HS, Etcheverry G: Intramucosal-arterial PCO2 gradient does not reflect intestinal dysoxia in anemic hypoxia. J Trauma. 2004, 57: 1211-1217. 10.1097/01.TA.0000107182.43213.4B.

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Author information

Correspondence to G Ferrara or A Dubin.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Keywords

  • Sham Group
  • Oxygen Transport
  • Ischemic Hypoxia
  • Artery Blood Flow
  • Grant Acknowledgment