Volume Based Resuscitation and Intestinal Microcirculation after Ischaemia/Reperfusion Injury: Results of an Exploratory Aortic Clamping Study in Pigs.

Abstract

OBJECTIVES: In the presence of ischaemia/reperfusion (I/R) induced endothelial injury, volume administration may not correlate with increased microcirculation. The aim of this study was to evaluate intestinal microcirculation after standardised sequential volume loading in an animal model of I/R injury following supracoeliac aortic clamping. METHODS: This was a prospective exploratory pilot animal study. Intestinal I/R injury was induced in eight pigs during experimental thoraco-abdominal aortic repair. After 6&#xa0;h of I/R, microcirculatory blood flow (mFlux, measured in the ileum using direct laser speckle contrast imaging) and macrohaemodynamic parameters (using trans-cardiopulmonary thermodilution) were measured and measurements were repeated after each of four sequential volume loading steps (VLS1 - 4). Each load was administered over 5&#xa0;min followed by another 5&#xa0;min for equilibration. RESULTS: All animals survived until after VLS4. After 6&#xa0;h of I/R cardiac output (CO) (p&#xa0;<&#xa0;.001) and mFlux (p&#xa0;<&#xa0;.001) had both decreased. CO increased again after VLS1 (p&#xa0;<&#xa0;.001) and VLS2 (p&#xa0;=&#xa0;.036), whereas mFlux did not change. In contrast, mFlux further decreased after VLS3 (p&#xa0;<&#xa0;.01) and VLS4 (p&#xa0;<&#xa0;.001), whereas CO did not change anymore. Extravascular lung water continued to increase after VLS2 (p&#xa0;=&#xa0;.046) and VLS4 (p&#xa0;=&#xa0;.049). CONCLUSIONS: I/R leads to impaired intestinal microcirculation, which was not restored by volume administration in spite of improved CO. In contrast, further volume administration exceeding preload reserves was associated with additional decreases in the intestinal microcirculation. The potentially negative effect of excessive volume resuscitation after I/R injury should encourage further translational research.