Gastrointestinaltrakt / Sepsis

Sepsis

Veränderte Durchblutung der Mukosa von Magen und Darm ist Folge und Ursache bei Sepsis. Die Messung der Sauerstoffversorgung der Mukosa ist mit dem O2C unter optischer Kontrolle mittels eines Endoskops möglich und bietet im Falle der Sättigungs- und Hämoglobinmessung den Vorteil unabhängig von Bewegungsartefakten zu sein. Dies ermöglicht eine Überwachung von Patienten mit Sepsis und deren Therapiekontrolle.

Erste experimentelle Ergebnisse wurden mit dem EMPHO gewonnen (Methode entspricht der des AbTisSpec / O2C-ATS), die wie schematisch in dem Diagramm dargestellt, unterschiedliche Sauerstoffsättigungsverteilungen in der Mukosa beim gesunden und beim septischen Patienten zeigen konnten.

Diagramm aus:

• Abnormalities of gastric mucosal oxygenation in septic shock: partial responsiveness to dopexamine.
  B. Temmesfeld-Wollbruck, A. Szalay, K. Mayer, H. Olschewski, W. Seeger, F. Grimminger;
  Am Respir Crit Care Med  1998 May;157(5 t 1):1586-92

Magen

Die Sonde kann blind oder über ein Endoskop in den Magen eingeführt werden. Die Kontrolle der Position erfolgt über das Hämoglobinspektrum. Die Zuverlässigkeit der Messungen wurde in Messungen am Magen gezeigt.

Literatur:

O2C

Papers

• Redistribution of intestinal microcirculatory oxygenation during acute hemodilution in pigs.
  L.A. Schwarte, A. Fournell, J. van Bommel, C. Ince; J Appl Physiol. 2005 Mar;98(3):1070-5. Epub 2004 Oct 8.
• Adrenomedullin reduces Staphylococcus aureus alpha-toxin-induced rat ileum microcirculatory damage.
  B. Brell, B. Temmesfeld-Wollbruck, I. Altzschner, E. Frisch, B. Schmeck, A. C. Hocke, N. Suttorp, S. Hippenstiel; Crit Care Med. 2005 Apr;33(4):819-26.
• O2C relevant data extracted from "Increase microvascular permeability and perfusion mismatch are hallmarks of sepis and spetical shock"
  
• Effect of increased cardiac output on hepatic and intestinal microcirculatory blood flow, oxygenation, and metabolism in hyperdynamic murine septic shock.
  G. Albuszies, P. Radermacher, J. Vogt, U. Wachter, S. Weber, M. Schoaff, M. Georgieff, E. Barth; Crit Care Med. 2005 Oct;33(10):2332-8.
  
  
• Redistribution of intestinal microcirculatory oxygenation during acute hemodilution in pigs.
  L. A. Schwarte, A. Fournell, J. van Bommel, C. Ince; J Appl Physiol. 2005 Mar;98(3):1070-5. Epub 2004 Oct 8.
• The effect of nitroglycerin on microvascular perfusion and oxygenation during gastric tube reconstruction.
  M. P. Buise, C. Ince, H. W. Tilanus, J. Klein, D. Gommers, J. van Bommel; Anesth Analg. 2005 Apr; 100(4): 1107-11
• Mechanisms of inducible nitric oxide synthase (iNOS) inhibition-related improvement of gut mucosal acidosis during hyperdynamic porcine endotoxemia.
  A. Pittner, M. Nalos, P. Asfar, Y. Yang, C. Ince, M. Georgieff, U.B. Bruckner, P. Radermacher, G. Froba; Intensive Care Med. 2003 Feb;29(2):312-6. Epub 2002 Dec 6.
• Reflectance Spectrophotometry and Tissue Oxygenation in Experimental and Clinical Practice
  M. P. Buise, J. van Bommel, and C. Ince; Yearbook of Intensive Care and Emergency Medicine 2003, Edited by J.-L. Vincent, Springer Verlag
• Mechanisms of inducible nitric oxide synthase (iNOS) inhibition-related improvement of gut mucosal acidosis during hyperdynamic porcine endotoxemia.
  Pittner A, Intensive Care Med  2003 Feb
• Efficacy of ice packs in the management of epistaxis
  
Teymoortash A, Sesterhenn A, Kress R, Sapundzhiev N, Werner JA. Clin Otolaryngology 2003 Dec; 28(6):545-7

Vorträge

• Determination of oxygen metabolism in tissues by combined white light spectrometry and laser spectroscopy – an overview about method and study results.
  A. Krug; Deutsche Gesellschaft für klinische Mikrozirkulation und Hämorheologie, 24. Jahrestagung in Rostock
• O2C relevant data extracted from "Determination of oxygen metabolism in tissues by combined white light spectrometry and laser spectroscopy – an overview about method and study results."
  
• Simultaneous, endoscopic Measurement Measurement of microvascular Oxygen Saturation and laser- Doppler Flow in gastric Mucosa
  A. Fournell, Nijmegen, Niederlande, 2000
• Application of NTG restores impaired microvascular perfusion in gastric tube reconstruction
  
Buise M P1, Van Bommel J, Klein J, Tilanus H W, Ince C; Academic Medical Center University of Amsterdam, Amsterdam, Netherland

Empho

Papers

• Levosimendan is superior to milrinone and dobutamine in selectively increasing microvascular gastric mucosal oxygenation in dogs.
  L.A. Schwarte, O. Picker, S.R. Bornstein, A. Fournell, T.W. Scheeren; Crit Care Med. 2005 Jan;33(1):135-42; discussion 246-7.
• O2C relavant data extracted from "Levosimendan is superior to milrinone and dobutamine in selectively increasing microvascular gastric mucosal oxygenation in dogs."
• Arginine vasopressin reduces intestinal oxygen supply and mucosal tissue oxygen tension.
  H. Knotzer, W. Pajk, S. Maier, R. Ladurner, A. Kleinsasser, V. Wenzel, M.W. Dunser, H. Ulmer, W.R. Hasibeder; Am J Physiol Heart Circ Physiol. 2005 Jul;289(1):H168-73. Epub 2005 Mar 11.
• Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs{dagger}
  Schwarte LA, Picker O, Hohne C, Fournell A, Scheeren TW.; Br J Anaesth. 2004 Jul 26
• Moderate increase in intraabdominal pressure attenuates gastric mucosal oxygen saturation in patients undergoing laparoscopy
  Schwarte LA, Scheeren TW, Lorenz C, De Bruyne F, Fournell A.; Anesthesiology. 2004 May;100(5):1081-7
• Dopamine under alpha1-blockade, but not dopamine alone or fenoldopam, increases depressed gastric mucosal oxygenation.
  Schwarte LA, Picker O, Schindler AW, Fournell A, Scheeren TW.; Crit Care Med. 2004 Jan;32(1):150-6
• Fenoldopam--but not dopamine--selectively increases gastric mucosal oxygenation in dogs
  Schwarte LA, Picker O, Schindler AW, Fournell A, Scheeren TW; Crit Care Med. 2003 Jul
• Assessment of microvascular oxygen saturation in gastric mucosa in volunteers breathing continuous positive airway pressure.
  Fournell A, Schwarte LA, Kindgen-Milles D, Muller E, Scheeren TW; Crit Care Med. 2003 Jun
• Jejunal tissue oxygenation and microvascular flow motion during hemorrhage and resuscitation
  Pajk W, Schwarz B, Knotzer H, Friesenecker B, Mayr A, Dunser M, Hasibeder W; Am J Physiol Heart Circ Physiol. 2002 Dec
• Clinical evaluation of reflectance spectrophotometry for the measurement of gastric microvascular oxygen saturation in patients undergoing cardiopulmonary bypass
  A. Fournell, J Cardiothorac Vasc Anesth, 2002
• Dopexamine but not dopamine increases gastric mucosal oxygenation during mechanical ventilation in dogs
  T. W. Scheeren, L. A. Schwarte, S. A. Loer, O. Picker, A. Fournell; Crit Care Med 2002 Apr;30(4):881-7
• Increased ileal-mucosal-arterial PCO2 gap is associated with impaired villus microcirculation in endotoxic pigs
  I. F. Tugtekin, Intensive Care Med, 2001
• Increased ileal-mucosal-arterial PCO2 gap is associated with impaired villus microcirculation in endotoxic pigs.
  I.F. Tugtekin, P. Radermacher, M. Theisen, M. Matejovic, A. Stehr, F. Ploner, K. Matura, C. Ince, M. Georgieff, K. Träger; Intensive Care Med. 2001 Apr; 27(4):757-766 ISSN: 0342-4642 (Paper) 1432-1238 (Online) DOI: 10.1007/s001340100871
• Effects of norepinephrine and phenylephrine on intestinal oxygen supply and mucosal tissue oxygen tension.
  B. Schwarz, H. Hofstotter, N. Salak, W. Pajk, H. Knotzer, A. Mayr, B. Labeck, R. Kafka, H. Ulmer, W.R. Hasibeder; Intensive Care Med. 2001 Mar;27(3):593-601.
• Effects of epinephrine on intestinal oxygen supply and mucosal tissue oxygen tension in pigs.
  N. Salak, W. Pajk, H. Knotzer, H. Hofstotter, B. Schwarz, A. Mayr, B. Labeck, R. Kafka, H. Ulmer, N. Mutz, W.R. Hasibeder; Crit Care Med. 2001 Feb;29(2):367-73 & Crit Care Med. 2001 Feb;29(2):454-5.
• Assessment of intestinal tissue oxygenation: the canary sings - but what does the twitter tell us?
  B. Temmesfeld-Wollbrück, Intensive Care Med, 2000
• Severe microcirculatory abnormalities elicited by E. coli hemolysin in the rabbit ileum mucosa.
  K. Mayer, Am J Respir Crit Care Med, 1999
• Abnormalities of gastric mucosal oxygenation in septic shock: partial responsiveness to dopexamine.
  B. Temmesfeld-Wollbrück, Am J Respir Crit Care Med, 1998
• The effects of progressive anemia on jejunal mucosal and serosal tissue oxygenation in pigs.
  M. Haisjackl, G. Luz, H. Sparr, R. Germann, N. Salak, B. Friesenecker, E. Deusch, S. Meusburger, W.R. Hasibeder; Anesth Analg. 1997 Mar;84(3):538-44
• Oxygenation of the intestinal mucosa in anaesthetized dogs is attenuated by intermittent positive pressure ventilation (IPPV) with positive end-expiratory pressure (PEEP)
  A. Fournell, Adv Exp Med Biol, 1997
• PEEP decreases oxygenation of the intestinal mucosa despite normalization of cardiac output
  A. Fournell, Adv Exp Med Biol, 1997
• Effects of short-term endotoxemia and dopamine on mucosal oxygenation in porcine jejunum.
  W.R. Hasibeder, R. Germann, H.J. Wolf, M. Haisjackl, H. Hausdorfer, B. Riedmann, J. Bonatii, E. Gruber, B. Schwarz, P. Waldenberger, B. Friesenecker, B. Furtner; Am J Physiol. 1996 Apr;270(4 Pt 1):G667-75.
• Dopamine-1-receptor stimulation and mucosal tissue oxygenation in the porcine jejunum.
  R. Germann, W. Hasibeder, M. Haisjackl, H. Sparr, G. Luz, H. Pernthaler, B. Friesenecker, J. Bonatti, E. Gruber, B. Schwarz; Crit Care Med. 1995 Sep;23(9):1560-6
• Vasomotion induces regular major oscillations in jejunal mucosal tissue oxygenation.
  W.R. Hasibeder, R. Germann, H. Sparr, M. Haisjackl, B. Friesenecker, G. Luz, H. Pernthaler, K. Pfaller, H. Maurer, O. Ennemoser; Am J Physiol. 1994 Jun;266(6 Pt 1):G978-86
• Dopamine and mucosal oxygenation in the porcine jejunum.
  R. Germann, M. Haisjackl, W. Hasibeder, H. Sparr, G. Luz, R. Plattner, H. Pernthaler, B. Friesenecker, M. Falk; J Appl Physiol. 1994 Dec;77(6):2845-52
• Reflectance spectrophotometry for the assessment of gastroduodenal mucosal perfusion.
  FW. Leung, T. Morishita, EH. Livingston, T. Reedy, PH. Guth; Am J Physiol. 1987 Jun;252(6 Pt 1):G797-804
• Gastroduodenal mucosal hemodynamics by endoscopic reflectance spectrophotometry.
  F.W. Leung, E. Slodownik, D.M. Jensen, G.M. Van Deventer, PH. Guth; Gastrointest Endosc. 1987 Aug;33(4):284-8
• Spektrophotometrische Untersuchungen an der Rektumschleimhaut in vivo
  Spectrophotometric measurements of the rectum mucosa in vivo
  A. Otto

Vorträge

• Hypercapnia increases gastric mucosal oxygenation during hemorrhagic shock
  L.A. Schwarte, I. Schwartges, A. Fournell, T.W.L. Scheeren, O. Picker; 18th Annual Congress of ESICM, Amsterdam, 2005
• Norepinephrine is superior to Epinephrine in increasing gastric mucosal oxygenation.
  L.A. Schwarte, I. Schwartges, A. Fournell, T.W.L. Scheeren, O. Picker; 18th Annual Congress of ESICM, Amsterdam, 2005