Minerva anestesiologica
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Minerva anestesiologica · Jul 2011
Rectal microcirculatory alterations after elective on-pump cardiac surgery.
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. ⋯ 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 pCO(2) gap >1.4,kPa, suggesting non-dysoxic perfusion in the majority of patients, despite the observed percentage of non-perfused crypts.