A study of splanchnic circulation and gastrointestinal mucosal function in critically ill patients.

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To determine the relationship between endotoxemia and splanchnic circulation in 29 adult patients who underwent heart surgery using hypothermic cardiopulmonary bypass (CPB), arterial and venous endotoxin levels (ETXa, ETXhv), bood angiotensin-2 level, arterial and hepatic venous blood oxygen saturations (SvO2, ShvO2), arterial and hepatic venous blood ketone body ratios (AKBR, HVKBR) and gastric intramucosal pH (pHi) were measured during and after surgery. Serum level of endotoxin levels were within a normal range (<10pg/ml) during surgery, and increased at the first post operative day (POD1) and the second post operative day (POD2). There was no significant difference between ETXa and ETXhv. Angiotensin-2 level increased during CPB and rapidly decreased after surgery. AKBR and HVKBR significantly decreased during CPB, and increased after surgery showing reciprocal change with the changes in KBRs. SvO2 and ShvO2 increased immediately after the initiation of CPB and decreased at the rewarming stage of CPB showing significant decrease in ShvO2. Results suggest that hepato-splanchnic circulation is deteriorated during cardiac surgery using cold CPB. The increase in blood endotoxin levels at POD1 and POD2 might be due to the wash-out from gastrointestinal organs after recovery of splanchnic circulation.