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

Ackland G, Grocott MP, Mythen MG - Crit Care (2000)

Bottom Line: Much of the data to support this idea comes from studies using gastric tonometry.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.

View Article: PubMed Central - PubMed

Affiliation: Centre for Anaesthesia, University College London, London, UK.

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.

Show MeSH
Gastric-arterial CO2 (PgCO2-PaCO2) gap before and after exercise to high oxygen consumption (VO2). Data from Chieverley-Williams S, Hurley R, Cox M, McCorkell S, Grocott MPW, Goldstone J and Mythen MG (unpublished data).
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Figure 5: Gastric-arterial CO2 (PgCO2-PaCO2) gap before and after exercise to high oxygen consumption (VO2). Data from Chieverley-Williams S, Hurley R, Cox M, McCorkell S, Grocott MPW, Goldstone J and Mythen MG (unpublished data).

Mentions: In contrast to feeding, acute exercise is associated with large increases in cardiac and active skeletal muscle blood flows, but reduced blood flow to skin, kidneys and organs perfused by the splanchnic circulation [89]. Using SMA and coeliac artery duplex ultrasound, a 50% reduction in the hepatosplenic and a 25-40% reduction in the mesenteric blood flow were demonstrated [90,91]. Simultaneous indocyanine green dye elimination measurements were consistent with the duplex data [90]. Results from studies using gastric tonometry also support the concept of a decrease in gastrointestinal perfusion occurring with exercise. Oarsmen subjected to 30 min of maximal exercise all had a significantly reduced gastric pHi, and this was proportionally greater than the reduction in arterial pH [92]. We have produced similar results using bicycle ergometer as an exercise challenge (unpublished data) (Fig. 5).


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

Ackland G, Grocott MP, Mythen MG - Crit Care (2000)

Gastric-arterial CO2 (PgCO2-PaCO2) gap before and after exercise to high oxygen consumption (VO2). Data from Chieverley-Williams S, Hurley R, Cox M, McCorkell S, Grocott MPW, Goldstone J and Mythen MG (unpublished data).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC137256&req=5

Figure 5: Gastric-arterial CO2 (PgCO2-PaCO2) gap before and after exercise to high oxygen consumption (VO2). Data from Chieverley-Williams S, Hurley R, Cox M, McCorkell S, Grocott MPW, Goldstone J and Mythen MG (unpublished data).
Mentions: In contrast to feeding, acute exercise is associated with large increases in cardiac and active skeletal muscle blood flows, but reduced blood flow to skin, kidneys and organs perfused by the splanchnic circulation [89]. Using SMA and coeliac artery duplex ultrasound, a 50% reduction in the hepatosplenic and a 25-40% reduction in the mesenteric blood flow were demonstrated [90,91]. Simultaneous indocyanine green dye elimination measurements were consistent with the duplex data [90]. Results from studies using gastric tonometry also support the concept of a decrease in gastrointestinal perfusion occurring with exercise. Oarsmen subjected to 30 min of maximal exercise all had a significantly reduced gastric pHi, and this was proportionally greater than the reduction in arterial pH [92]. We have produced similar results using bicycle ergometer as an exercise challenge (unpublished data) (Fig. 5).

Bottom Line: Much of the data to support this idea comes from studies using gastric tonometry.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.

View Article: PubMed Central - PubMed

Affiliation: Centre for Anaesthesia, University College London, London, UK.

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.

Show MeSH