Metabolism monitoring with microdialysis in the intensive care
Authors:
Filip Burša 1; Tomáš Olos 2; Leopold Pleva 3; Roman Kula 1; Jan Jahoda 1; Václav Procházka 4; Ivo Kopáček 3
Authors place of work:
Anesteziologicko resuscitační klinika FN, Ostrava
1; Oddělení pediatrické, resuscitační a intenzivní péče FN, Ostrava
2; Traumatologické centrum FN, Ostrava
3; Ústav radiodiagnostický FN, Ostrava
4
Published in the journal:
Čas. Lék. čes. 2011; 150: 605-609
Category:
Review Articles
Summary
Therapy of haemorrhagic shock presents a huge challenge nowadays. Changes in circulation and metabolism are preceded with changes in cells, vessels and extracellular fluid. The main disorder takes place in microcirculation. Monitoring of extracellular fluid is possible with microdialysis. This method was verified on animal models and a became base of many clinical examinations in the world. First of all it is monitoring of lactate, pyruvate, glucose and glycerole as main markers of cell metabolism. Tissue condition can be described not only with absolute values but also as relations between individual parameters e.g. lactate/pyruvate and lactate/glucose. These values do not only inform us about forthcoming change from aerobic to anaerobic metabolism but also about the degree of reperfusion. Precious information about mitochondrial dysfunction which is the essence of multiorgan dysfunction in intensive care is collected as well. Based on changes we can asses the quality of resuscitation care together with speed of shock elimination, increasing oxygen delivery and mitochondrial dysfunction treatment.
Key words:
hemorrhagic shock, microdialysis, lactate, muscle tissue.
Zdroje
1. Waelgaard L, Thorgersen EB, Line PD, et. al. Microdialysis monitoring of liver grafts by metabolic parameters, cytokine production, and complement activation. Transplantation 2008; 86(8): 1096–1103.
2. Cibiček N, Živna H, Čermakova E, et. al. Sledování krevního průtoku v žaludku pomocí mikrodialýzy na potkaním modelu ischemie-reperfuze Klin Biochem Metab 2010; 18(39): 36–240.
3. Rostami E, Bellander BM. Monitoring of glucose in brain, adipose tissue, and peripheral blood in patients with traumatic brain injury: a microdialysis study. J Diabetes Sci Technol 2011; 5(3): 596–604.
4. Liu X, Kruger PS, Roberts MS. How to Measure Pharmacokinetics in Critically Ill Patients? Curr Pharm Biotechnol 2011; May 10 [Epub ahed of print].
5. Douglas A, Altukroni M, Udy AA, et. al. The pharmacokinetics of cefazolin in patients undergoing elective & semi–elective abdominal aortic aneurysm open repair surgery. BMC Anesthesiol 2011; 11: 5.
6. Simon F, Karlander, LE, et. al. Continous assessment of concentrations of cytokines in experimentak injurie sof the extremity. Exp Med 2009; 2(4): 354–362.
7. Roberts JA, Roberts MS, Semark A, et al. Antibiotic dosing in the ‘at risk’ critically ill patient: Linking pathophysiology with pharmacokinetics/pharmacodynamics in sepsis and trauma patients. BMC Anesthesiol 2011; 11: 3.
8. Jansson L. et al. Postoperative on-line monitoring with intraperitoneal microdialysis is a sensitive clinical method for measuring increased anaerobic metabolism that correlates to the cytokine response. Scand 2004; 39(5): 434–439.
9. Widegren U, Hickner RC, Jorfeldt L, Henriksson J. Muscle blood flow response to mental stress and adrenaline infusion in man: microdialysis ethanol technique compared to (133)Xe clearance and venous occlusion plethysmography. Clin Physiol Funct Imaging 2010; 30(2): 152–161.
10. Farnebo S, Zettersten EK, Samuelsson A, Tesselaar E, Sjöberg F. Assessment of blood flow changes in human skin by microdialysis urea clearance. Microcirculation 2011; 18(3): 198–204.
11. Farnebo S, Samuelsson A, Henriksson J, et. al. Urea clearance: a new method to register local changes in blood flow in rat skeletal muscle based on microdialysis. Clin 2010; 30(1): 57–63.
12. Bruno L, Sébastien G, Patricia F, et al. Relation between muscle Na+K+ ATPase activity and raised lactate concentration in septic shock:a prospective study. The Lancet 2005; 365: 9462.
13. Ohashi S, et al. Utility of microdialysis to detect the lactate/pyruvateratio in subcutaneous tissue for the reliable monitoring of hemorrhagic shock. Res 2009; 45(6): 269–278.
14. Samuelsson A, Steinvall I, Sjoberg F. Microdialysis shows metabolit effects in skin during fluid resuscitation in burn-injured patiens. Crit Care 2006; 10(6): R172.
15. Farnebo S, Zettersten A. Assessment of blood flow changes in human skin by microdialysis urea clearance. Microcirculation 2011; 18(3): 198–204.
16. Levy B, Desebbe O, Montemont C, et al. Increased aerobic glycolysis through beta2 stimulation is a common mechanism involved in lactate formation during shock states. Shock 2008; 30(4): 417–421.
17. Krejci V, Hiltebrand L, et al. Decreasing gut wall glucose as an early marker of impaired intestinal perfusion Critical Care Medicine 2006; 34: 2406–2414.
18. Allam Cl, Xu M, Mendendorp A. Determination of Renal Hypothermic Temperature Adequacy for Renoprotection During Ischemia Using Renal Interstitial Glycerol Concentrations in a Porcine Model Urology 2011; 77(2): 508.e1–4.
19. SolligĆrd E, Jue IS, Bakkelund K, et al. Gut luminal microdialysis of glycerol as a marker of intestinal ischemic injury and recovery. Department of Anesthesiology and Intensive Care 2005; 33(10): 2278–2285.
20. Petriczko E, Horodnicka-Jozwa A, Grabowska-Wnuk W, et al. Interstitial measurements of glucose, glycerol and lactate in adolescents with decompensated type 1 diabetes. Neuro Endocrinol Lett 2010; 31(4): 559–567.
21. Trzeciak S, McCoy JV, Philip Dellinger R, et al. Early increases in microcirculatory perfusion during protocol–directed resuscitation are associated with reduced multi–organ failure at 24 h in patients with sepsis. Intensive Care Med 2008; 34(12): 2210–2217.
22. Adams RC, Lundy JS. Anesthesia in cases of poor surgical risk. Some suggestions for decreasing the risk. Surg Gynecol Obstet 1942; 74: 1011–1019.
23. Weiskopf RB, Viele MK, Feiner J, Kelley, et al. Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA 1998; 279: 217–221.
24. Lieberman JA, Weiskopf RB, Kelley SD, et al. Critical oxygen delivery in conscious humans is less than 7.3 mL O2 × kg (-1) × min (-1). Anesthesiology 2000; 92: 407–413.
25. Brimacombe J, Skippen P, Talbutt P. Acute anemia to a hemoglobin of 14 g/lwith survival. Anaesth Intensive Care 1991; 19: 581–583.
26. Hill SR, Carless PA, Henry DA, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev2002: CD002042.
27. Madjdpour C, Spahn DR, Weiskopf RB. Anemia and perioperative red blood cell transfusion:a matter of tolerance. Crit Care Med 2006; 34: S102–108.
28. Walsh TS, Saleh EE. Anaemia during critical illness. Br J Anaesth 2006; 97: 278–291.
29. Hebert PC, Wells G, Blajchman MA, et. al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999; 340: 409–417.
30. Koch CG, Li L, Duncan AI, Mihaljevic T, et al. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg 2006; 81: 1650–1657.
31. Vincent JL, Baron J-F, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. JAMA 2002; 288: 1499–1507.
32. Stainsby D, MacLennan S, Thomas, D et al. Guidelines on the management of massive blood loss. Br J Haematol 2006; 135(5): 634–641.
33. Sehgal LR, Zebala LP, Takagi I, et al. Evaluation of oxygen extraction ratio as a physiologic transfusion trigger in coronary artery bypass graft surgery patients. Transfusion 2001; 41: 591–595.
34. Vázquez BY, Hghtower CM, Martini J. Vasoactive hemoglobin solution improves survival in hemodilution followed by hemorrhagic shock. Crit Care Med 2011; 39(6): 1461–1466.
35. Boldt J, Ince C. The impact of fluid therapy on microcirculation and tissue oxygenation in hypovolemic patients: a review. Care Med 2010; 36(8): 1299–1308.
36. Samir M Fakhry, Fata P. How low is too low? Cardiac risks with anemia. Crit Care 2004; 8(Suppl 2): S11–14.
37. Dubin A, Pozo MO, Ferrara G. Systemic and microcirculatory responses to progressive hemorrhage. Intensive Care Med 2009; 35(3): 556–564.
Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
Journal of Czech Physicians
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- What Effect Can Be Expected from Limosilactobacillus reuteri in Mucositis and Peri-Implantitis?
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Current status of pancreatic cancer diagnosis
- Postoperative recurrence of Crohn’s disease
- The role of estrogens in regulations of biological processes involved into wound healing – a review
- Babyboxes in the Czech Republic – what next?