Early detection of gut ischemia-reperfusion injury during aortic abdominal aneurysmectomy: a pilot, observational study.
Fiche publication
Date publication
août 2013
Auteurs
Membres identifiés du Cancéropôle Est :
Pr MEYER Nicolas
Tous les auteurs :
Collange O, Tamion F, Meyer N, Quillard M, Kindo M, Hue G, Veber B, Dureuil B, Plissonnier D
Lien Pubmed
Résumé
OBJECTIVE: D-lactate is the enantiomer of L-lactate, which is measured routinely in clinical practice to assess cell hypoxia. D-lactate has been proposed as a specific marker of gut ischemia-reperfusion (IR), particularly during surgery for ruptured abdominal aortic aneurysms. The aim of this study was to compare the use of D-lactate measurement and colonic tonometry (taken as a reference method) for gut IR detection during elective infrarenal aortic aneurysm (IrAA) surgery. DESIGN: Prospective, monocenter, observational study. SETTING: Vascular surgery unit, university hospital. PARTICIPANTS: Candidates for elective IrAA surgery. INTERVENTIONS: Patients without (controls) and with gut IR (defined as DeltaCO2>2.6 kPa) were compared retrospectively. MEASUREMENT AND MAIN RESULTS: D-lactate levels were compared with colonic perfusion levels (DeltaCO2), as assessed by colonic tonometry, at 7 time points during surgery and until 24 hours after surgery. D-lactate also was measured in mesenteric vein blood before and after gut reperfusion. Plasma TNF-alpha level was measured at the same time points to assess systemic inflammatory response. Eighteen patients requiring elective IrAA surgery were included. The DeltaCO2 and TNF-alpha level varied significantly over time. There was a significant DeltaCO2 peak at the end of clamping (2.6+/-1.8 kPa, p = 0.006) and a significant peak in TNF-alpha level after 1 hour of reperfusion (183+/-53 ng/L, p = 0.05). D-lactate levels were undetectable in systemic and mesenteric blood in all the patients throughout the study period. Gut IR patients (n = 6) experienced a longer overall duration of intraoperative hypotensive episodes and received more catecholamines than the controls (n = 12). CONCLUSIONS: Compared with colonic tonometry, D-lactate was not a reliable biomarker of gut IR during elective IrAA surgery.
Référence
J Cardiothorac Vasc Anesth. 2013 Aug;27(4):690-5