Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-18T11:04:57.941Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of intra-aortic balloon counterpulsation on parameters of tissue oxygenation

Published online by Cambridge University Press:  27 January 2006

H. Heinze ,
M. Heringlake ,
P. Schmucker  and
T. Uhlig
H. Heinze
Affiliation:
University of Luebeck, Department of Anaesthesiology, Luebeck, Germany
M. Heringlake
Affiliation:
University of Luebeck, Department of Anaesthesiology, Luebeck, Germany
P. Schmucker
Affiliation:
University of Luebeck, Department of Anaesthesiology, Luebeck, Germany
T. Uhlig
Affiliation:
University of Luebeck, Department of Anaesthesiology, Dietrich-Bonnhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Germany
Get access

Extract

Summary

Background and objective: To investigate the effects of intra-aortic balloon pump therapy on parameters of global and regional oxygenation in patients undergoing cardiac surgery. Methods: As part of a large surveillance study in cardiac surgery patients (n = 266) we retrospectively analyzed the course of 28 patients requiring intra-aortic balloon pump therapy. Patients were grouped according to the time point of pump insertion (during weaning from cardiopulmonary bypass: group early intra-aortic balloon pumping (n = 17); after admission to the intensive care unit: group late intra-aortic balloon pumping (n = 9). Haemodynamic and tonometric variables, arterial lactate, and use of catecholamines were measured hourly. Measurements and results: Cardiac index increased in both groups after intra-aortic balloon pump insertion (2.2 ± 0.5 baseline; 3.4 ± 0.8 L min−1 m−2 4 h later (group early intra-aortic balloon pumping); 2.8 ± 0.5 baseline, 3.6 ± L min−1 m−2 4 h later (group later intra-aortic balloon pumping), each P < 0.05), there were no differences between groups. Arterial lactate values increased in group later intra-aortic balloon pumping after pump insertion to a maximum 2 h later (8.4 ± 6.1 mmol L−1 baseline; 12.7 ± 7.4 mmol L−1, P < 0.05), and decreased continuously afterwards. The difference of arterial and gastric CO2 showed a sharp decrease after pump insertion in group later intra-aortic balloon pumping (26.4 ± 9.8 baseline; 7.0 ± 11.1 mmHg, P < 0.05). There were no differences between groups. Epinephrine doses were higher in group later intra-aortic balloon pumping (P < 0.05). Conclusions: Intra-aortic balloon pump therapy improved global and regional splanchnic oxygenation in cardiac surgery patients with low-cardiac-output syndrome. Gastro-intestinal tonometry could provide additional information concerning tissue oxygenation. Patients with later intra-aortic balloon pump insertion needed more catecholamine therapy to achieve similar haemodynamic values.

Keywords

TONOMETRY, gastric tonometryCO2-gapSPLANCHNIC CIRCULATIONCOUNTERPULSATIONINTRA-AORTIC BALLOON PUMPINGLACTIC ACIDOSISINTENSIVE CARECARDIAC SURGICAL PROCEDURESCARDIOGENIC SHOCK
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 7 , July 2006 , pp. 555 - 562
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mythen MG, Webb AR. The role of gut mucosal hypoperfusion in the pathogenesis of post operative organ dysfunction. Intens Care Med 1994; 20 (3): 203–209.Google Scholar
Lebuffe G, Decoene C, Pol A, Prat A, Vallet B. Regional capnometry with air-automated tonometry detects circulatory failure earlier than conventional hemodynamics after cardiac surgery. Anesth Analg 1999; 89 (5): 1084–1090.Google Scholar
Hamilton-Davies C, Mythen MG, Salmon JB, Jacobson D, Shukla A, Webb AR. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intens Care Med 1997; 23 (3): 276–281.Google Scholar
Trinder TJ, Lavery GG, Fee JP, Lowry KG. Low gastric intramucosal pH: incidence and significance in intensive care patients. Anaesth Intens Care 1995; 23 (3): 315–321.Google Scholar
Kavarana MN, Frumento RJ, Hirsch AL, Oz MC, Lee DC, Bennett-Guerrero E. Gastric hypercarbia and adverse outcome after cardiac surgery. Intens Care Med 2003; 29 (5): 742–748.Google Scholar
Mehlhorn U, Kroner A, de Vivie ER. 30 years clinical intra-aortic balloon pumping: facts and figures. Thorac Cardiovasc Surg 1999; 47 (Suppl 2): 298–303.Google Scholar
Janssens U, Graf J, Koch KC, vom Dahl J, Hanrath P. Gastric tonometry in patients with cardiogenic shock and intra-aortic balloon counterpulsation. Crit Care Med 2000; 28 (10): 3449–3455.Google Scholar
Creteur J, De Backer D, Vincent JL. Monitoring gastric mucosal carbon dioxide pressure using gas tonometry: in vitro and in vivo validation studies. Anesthesiology 1997; 87 (3): 504–510.Google Scholar
Mythen MG, Webb AR. Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complications and cost. Intens Care Med 1994; 20 (2): 99–104.Google Scholar
Hamilton-Davies C, Barclay GR, Cardigan RA et al. Relationship between preoperative endotoxin immune status, gut perfusion, and outcome from cardiac valve replacement surgery. Chest 1997; 112 (5): 1189–1196.Google Scholar
Croughwell ND, Newman MF, Lowry E et al. Effect of temperature during cardiopulmonary bypass on gastric mucosal perfusion. Br J Anaesth 1997; 78 (1): 34–38.Google Scholar
Jakob SM, Ruokonen E, Takala J. Assessment of the adequacy of systemic and regional perfusion after cardiac surgery. Br J Anaesth 2000; 84 (5): 571–577.Google Scholar
Gutierrez G, Palizas F, Doglio G et al. Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 1992; 339 (8787): 195–199.Google Scholar
Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 1995; 130 (4): 423–429.Google Scholar
Ivatury RR, Simon RJ, Islam S, Fueg A, Rohman M, Stahl WM. A prospective randomized study of end points of resuscitation after major trauma: global oxygen transport indices versus organ-specific gastric mucosal pH. J Am Coll Surg 1996; 183 (2): 145–154.Google Scholar
Chapman MV, Mythen MG, Webb AR, Vincent JL. Report from the meeting: Gastrointestinal Tonometry: State of the Art. Intens Care Med 2000; 26: 613–622.Google Scholar
Hamilton MA, Mythen MG. Gastric tonometry: where do we stand? Curr Opin Crit Care 2001; 7 (2): 122–127.Google Scholar
Kolkman JJ, Otte JA, Groeneveld AB. Gastrointestinal luminal pCO2 tonometry: an update on physiology, methodology and clinical applications. Br J Anaesth 2000; 84 (1): 74–86.Google Scholar
Heinonen PO, Jousela IT, Blomqvist KA, Olkkola KT, Takkunen OS. Validation of air tonometric measurement of gastric regional concentrations of CO2 in critically ill septic patients. Intens Care Med 1997; 23 (5): 524–529.Google Scholar
Janssens U, Graf J, Koch KC, Hanrath P. Gastric tonometry: in vivo comparison of saline and air tonometry in patients with cardiogenic shock. Br J Anaesth 1998; 81 (5): 676–680.Google Scholar
Schlichtig R, Mehta N, Gayowski TJ. Tissue-arterial pCO2 difference is a better marker of ischemia than intramural pH (pHi) or arterial pH-pHi difference. J Crit Care 1996; 11 (2): 51–56.Google Scholar
Bams JL, Kolkman JJ, Roukens MP et al. Reliable gastric tonometry after coronary artery surgery: need for acid secretion suppression despite transient failure of acid secretion. Intens Care Med 1998; 24 (11): 1139–1143.Google Scholar
Kloner RA, Jennings RB. Consequences of brief ischemia: Stunning, preconditioning, and their clinical implications Part 1. Circulation 2001; 104: 2981–2989.Google Scholar
Gardeback M, Settergren G, Ohquist G, Tiren C. Effect of dopexamine on calculated low gastric intramucosal pH following valve replacement. Acta Anaesthesiol Scand 1995; 39 (5): 599–604.Google Scholar
Nygren A, Thoren A, Ricksten SE. Effects of norepinephrine alone and norepinephrine plus dopamine on human intestinal mucosal perfusion. Intens Care Med 2003; 29 (8): 1322–1328.Google Scholar
Reilly PM, Bulkley GB. Vasoactive mediators and splanchnic perfusion. Crit Care Med 1993; 21 (Suppl 2): S55–S68.Google Scholar
Welsby I, Mythen MG. Gut perfusion during cardiac surgery. Curr Opin Anaesth 1997; 10: 34–39.Google Scholar
Burgener D, Laesser M, Treggiari-Venzi M et al. Endothelin-1 blockade corrects mesenteric hypoperfusion in a porcine low cardiac output model. Crit Care Med 2001; 29 (8): 1615–1620.Google Scholar
Landreneau R, Horton J, Cochran R. Splanchnic blood flow response to intraaortic balloon pump assist of hemorrhagic shock. J Surg Res 1991; 51 (4): 281–287.Google Scholar
Shin H, Yozu R, Sumida T, Kawada S. Acute ischemic hepatic failure resulting from intraaortic balloon pump malposition. Eur J Cardiothorac Surg 2000; 17 (4): 492–494.Google Scholar
Shimamoto H, Kawazoe K, Kito H, Fujita T, Shimamoto Y. Does juxtamesenteric placement of intra-aortic balloon interrupt superior mesenteric flow? Clin Cardiol 1992; 15 (4): 285–290.Google Scholar
Dietl CA, Berkheimer MD, Woods EL, Gilbert CL, Pharr WF, Benoit CH. Efficacy and cost-effectiveness of preoperative IABP in patients with ejection fraction of 0.25 or less. Ann Thorac Surg 1996; 62: 401–409.Google Scholar
Christenson JT, Badel P, Simonet F, Schmuziger M. Preoperative intraaortic balloon pump enhances cardiac perfusion and improves the outcome of redo CABG. Ann Thorac Surg 1997; 64 (5): 1237–1244.Google Scholar
Fink MP. Bench-to-bedside review: Cytopathic hypoxia. Crit Care 2002; 6 (6): 491–499.Google Scholar
Vary TC. Sepsis-induced alterations in pyruvate dehydrogenase complex activity in rat skeletal muscle: effects on plasma lactate. Shock 1996; 6 (2): 89–94.Google Scholar
Maillet JM, Le Besnerais P, Cantoni M et al. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest 2003; 123 (5): 1361–1366.Google Scholar
Rivers E, Nguyen B, Havstad S et al. Early-goal-directed therapy in the treatment of severe sepsis and septic shock. New Engl J Med 2001; 345 (19): 1368–1377.Google Scholar
Polonen P, Ruokonen E, Hippeläinen M, Pöyhönenm M, Takala J. A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 2000; 90: 1052–1059.Google Scholar