Articles: splanchnic-circulation-physiology.
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Pediatric cardiology · Apr 2011
Randomized Controlled Trial Multicenter Study Comparative StudyCeliac artery flow pattern in infants with single right ventricle following the Norwood procedure with a modified Blalock-Taussig or right ventricle to pulmonary artery shunt.
A potential advantage of the right ventricle to pulmonary artery versus modified Blalock-Taussig shunt in patients undergoing the Norwood procedure is limitation of diastolic runoff from the systemic to pulmonary circulation. We evaluated mesenteric flow patterns and gastrointestinal outcomes following the Norwood procedure associated with either shunt type. Patients randomized to a right ventricle to pulmonary artery versus modified Blalock-Taussig shunt in the Pediatric Heart Network Single Ventricle Reconstruction Trial at centers participating in this ancillary study were eligible for inclusion; those with active necrotizing enterocolitis, sepsis, or end-organ dysfunction were excluded. ⋯ Median celiac artery resistive index (an indicator of resistance to perfusion) was higher in the modified Blalock-Taussig shunt group (n = 19) versus the right ventricle to pulmonary artery shunt group (n = 25) [1.00 (IQR = 0.84-1.14) vs. 0.82 (IQR = 0.74-1.00), p = 0.02]. There was no difference in interstage weight gain, necrotizing enterocolitis, or feeding intolerance episodes between the groups. The celiac artery resistive index was higher in patients with the modified Blalock-Taussig shunt versus the right ventricle to pulmonary artery shunt but was not associated with measured gastrointestinal outcomes.
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Lung recruitment maneuvers (RMs), used to reopen atelectatic lung units and to improve oxygenation during mechanical ventilation, may result in hemodynamic impairment. We hypothesize that pulmonary arterial hypertension aggravates the consequences of RMs in the splanchnic circulation. Twelve anesthetized pigs underwent laparotomy and prolonged postoperative ventilation. ⋯ The corresponding recovery to at least 90% of baseline regional blood flow and organ perfusion lasted 1 to 5 min. Importantly, the decreases in regional blood flows and organ perfusion and the time to recovery of these flows did not differ from the controls. In conclusion, lipopolysaccharide-induced pulmonary arterial hypertension does not aggravate the RM-induced significant but short-lasting decreases in systemic, regional, and organ blood flows.
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Splanchnic organs are particularly vulnerable to hypoperfusion. Currently, there is no technique that allows for the continuous estimation of splanchnic blood oxygen saturation (SpO(2)). As a preliminary to developing a suitable splanchnic SpO(2) sensor, a new reflectance fiber optic photoplethysmographic (PPG) sensor and processing system are developed. ⋯ Preliminary PPG signals from various splanchnic organs and the periphery are obtained from six anaesthetized patients. The normalized amplitudes of the splanchnic PPGs are, on average, approximately the same as those obtained simultaneously from the periphery. These observations suggest that fiber optic pulse oximetry may be a valid monitoring technique for splanchnic organs.
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Anesthesia and analgesia · Aug 2009
The association of hemodilution and transfusion of red blood cells with biochemical markers of splanchnic and renal injury during cardiopulmonary bypass.
Hemodilution is the main cause of a low hematocrit concentration during cardiopulmonary bypass. This low hematocrit may be insufficient for optimal tissue oxygen delivery and often results in packed cell transfusion. Our objective in this study was to find a relationship between intraoperative hematocrit and allogeneic blood transfusion on release of postoperative injury markers from the kidneys and the splanchnic area. ⋯ The results support the concept that hemodilution below an intraoperative hematocrit of 24% and consequently transfusion of red blood cells is related to release of injury markers of the kidneys and splanchnic area.
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Acta cirúrgica brasileira · Jul 2009
Systemic evaluation on ischemia and reperfusion injury of splanchnic organs in rats.
To evaluate hemodynamic and systemic changes during and after splanchnic ischemia and reperfusion (I/R). ⋯ The model of ischemia used causes systemic changes, which are evidenced by hypotension, decrease in mesenteric blood flow, heart rate and esophageal temperature.