Articles: splanchnic-circulation-physiology.
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The gastrointestinal (GI) system, is most vulnerable to hypoperfusion among the splanchnic organs. Disturbed perfusion of the mesenteric area may lead to GI dysfunction, cause further injury to the patients and even vital outcomes. However, due to the limitation of detection methods, the hemodynamic influences on mesenteric blood flow in clinical practice are not fully understood. ⋯ Based on the best current evidence from these sources, we described the major influences on mesenteric blood flow in the context of physiologic accommodation, disease-related effects and the consequences of medical interventions related to shock conditions. During circulatory shock, sepsis, and medical interventions related to shock treatment, mesenteric blood flow changes and shows different features. We need to carefully consider these issues when making medical decisions, and more work needs to be done on early detection of GI hypoperfusion and its accurate correlation with GI dysfunction.
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Observational Study
Cerebral, renal, and splanchnic tissue oxygen saturation values in healthy term newborns.
To determine cerebral regional tissue oxygen saturation (CrSO2), renal regional tissue oxygen saturation (RrSO2), and splanchnic regional tissue oxygen saturation (SrSO2) values in healthy term infants. ⋯ There appears to be consistency in rSO2 values in healthy newborns. CrSO2 was similar on both days. Differences observed in RrSO2 and SrSO2 between days may represent a shift in somatic blood flow distribution taking place during the first day of life.
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Pediatric cardiology · Apr 2014
Splanchnic oxygen saturation immediately after weaning from cardiopulmonary bypass can predict early postoperative outcomes in children undergoing congenital heart surgery.
This study compared the abilities of cerebral, renal, and splanchnic regional oxygen saturation (rSO2) immediately after weaning from cardiopulmonary bypass (CPB) to predict early postoperative outcomes for children undergoing congenital heart surgery. The study enrolled 73 children (ages 0.1-72 months) undergoing corrective or palliative cardiac surgery requiring CPB. Laboratory and hemodynamic variables were analyzed at the time of successful weaning from CPB. ⋯ However, splanchnic rSO2 was the only independent factor predicting VIS(max) (β = -0.302, P = 0.021), duration of mechanical ventilation (β = -0.390, P = 0.002), and postoperative hospital length of stay (β = -0.340, P = 0.001) by multivariate analyses. Splanchnic rSO2 had a larger receiver operating characteristic area under the curve (AUC) for determining high VIS(max), prolonged mechanical ventilation, and longer postoperative hospital stay (AUC 0.775, 0.792, and 0.776, respectively) than cerebral (AUC 0.630, 0.638, and 0.632, respectively) and renal (AUC 0.703, 0.716, and 0.715, respectively) rSO2. After weaning from CPB, splanchnic rSO2 may be superior to rSO2 measured from brain and kidney in predicting an increased requirement for vasoactive inotropic support, a prolonged mechanical ventilation, and a longer postoperative hospital stay for children.
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Early and aggressive treatment of circulatory failure is associated with increased survival, highlighting the need for monitoring methods capable of early detection. Vasoconstriction and decreased oxygenation of the splanchnic circulation are a sentinel response of the cardiovasculature during circulatory distress. Thus, we measured esophageal oxygenation as an index of decreased tissue oxygen delivery caused by three types of ischemic insult, occlusive decreases in mesenteric blood flow, and hemodynamic adaptations to systemic hypoxia and simulated hemorrhagic stress. ⋯ All modes of oximetry monitoring and arterial blood pressure were correlated with mesenteric artery flow during acute hemorrhage. Esophageal StO2 demonstrated a greater decrease from baseline levels as well as a more rapid return to baseline levels during reinfusion of the withdrawn blood. These experiments suggest that monitoring esophageal StO2 may be useful in the detection of decreased mesenteric oxygen delivery as may occur in conditions associated with hypoperfusion or hypoxia.
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Early human development · Jun 2013
ReviewGlobal perfusion assessment and tissue oxygen saturation in preterm infants: where are we?
Near infrared spectroscopy (NIRS) monitoring is a new challenge for clinicians who deal with early detection of dangerous hypoperfusion in the brain, as well as in splanchnic and renal districts in critically ill preterm infants. Previous studies performed on infants and children with congenital heart disease, demonstrated the efficacy of this non-invasive method in managing hypoperfusive states pre, post and during cardiac surgery. ⋯ Early identification of silent hypoperfusion has made NIRS use in preterm infants very interesting for neonatologists, especially where other techniques have failed. In this work, literature on this topic has been carefully examined, particularly the "two site NIRS" use in preterm infants, to evaluate how regional splanchnic oxygen saturation changes, both in physiological events, such as enteral feeding and in hemodynamic disorders, that occur in patients with significant patent ductus and in hypoperfusive states that lead to necrotizing enterocolitis.