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Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients
BACKGROUND: Intestinal ischemia is a common complication with obscure pathophysiology in critically ill patients. Since insufficient delivery of oxygen is discussed, we investigated the influence of oxygen delivery, hemoglobin, arterial oxygen saturation, cardiac index and the systemic vascular resi...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270469/ https://www.ncbi.nlm.nih.gov/pubmed/34242347 http://dx.doi.org/10.1371/journal.pone.0254352 |
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author | Schoettler, Jochen J. Kirschning, Thomas Hagmann, Michael Hahn, Bianka Fairley, Anna-Meagan Centner, Franz-Simon Schneider-Lindner, Verena Herrle, Florian Tzatzarakis, Emmanouil Thiel, Manfred Krebs, Joerg |
author_facet | Schoettler, Jochen J. Kirschning, Thomas Hagmann, Michael Hahn, Bianka Fairley, Anna-Meagan Centner, Franz-Simon Schneider-Lindner, Verena Herrle, Florian Tzatzarakis, Emmanouil Thiel, Manfred Krebs, Joerg |
author_sort | Schoettler, Jochen J. |
collection | PubMed |
description | BACKGROUND: Intestinal ischemia is a common complication with obscure pathophysiology in critically ill patients. Since insufficient delivery of oxygen is discussed, we investigated the influence of oxygen delivery, hemoglobin, arterial oxygen saturation, cardiac index and the systemic vascular resistance index on the development of intestinal ischemia. Furthermore, we evaluated the predictive power of elevated lactate levels for the diagnosis of intestinal ischemia. METHODS: In a retrospective case-control study data (mean oxygen delivery, minimum oxygen delivery, systemic vascular resistance index) of critical ill patients from 02/2009–07/2017 were analyzed using a proportional hazard model. General model fit and linearity were tested by likelihood ratio tests. The components of oxygen delivery (hemoglobin, arterial oxygen saturation and cardiac index) were individually tested in models. RESULTS: 59 out of 874 patients developed intestinal ischemia. A mean oxygen delivery less than 250ml/min/m(2) (LRT vs. null model: p = 0.018; LRT for non-linearity: p = 0.012) as well as a minimum oxygen delivery less than 400ml/min/m(2) (LRT vs null model: p = 0.016; LRT for linearity: p = 0.019) were associated with increased risk of the development of intestinal ischemia. We found no significant influence of hemoglobin, arterial oxygen saturation, cardiac index or systemic vascular resistance index. Receiver operating characteristics analysis for elevated lactate levels, pH, CO(2) and central venous saturation was poor with an area under the receiver operating characteristic of 0.5324, 0.52, 0.6017 and 0.6786. CONCLUSION: There was a significant correlation for mean and minimum oxygen delivery with the incidence of intestinal ischemia for values below 250ml/min/m(2) respectively 400ml/min/m(2). Neither hemoglobin, arterial oxygen saturation, cardiac index, systemic vascular resistance index nor elevated lactate levels could be identified as individual risk factors. |
format | Online Article Text |
id | pubmed-8270469 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-82704692021-07-21 Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients Schoettler, Jochen J. Kirschning, Thomas Hagmann, Michael Hahn, Bianka Fairley, Anna-Meagan Centner, Franz-Simon Schneider-Lindner, Verena Herrle, Florian Tzatzarakis, Emmanouil Thiel, Manfred Krebs, Joerg PLoS One Research Article BACKGROUND: Intestinal ischemia is a common complication with obscure pathophysiology in critically ill patients. Since insufficient delivery of oxygen is discussed, we investigated the influence of oxygen delivery, hemoglobin, arterial oxygen saturation, cardiac index and the systemic vascular resistance index on the development of intestinal ischemia. Furthermore, we evaluated the predictive power of elevated lactate levels for the diagnosis of intestinal ischemia. METHODS: In a retrospective case-control study data (mean oxygen delivery, minimum oxygen delivery, systemic vascular resistance index) of critical ill patients from 02/2009–07/2017 were analyzed using a proportional hazard model. General model fit and linearity were tested by likelihood ratio tests. The components of oxygen delivery (hemoglobin, arterial oxygen saturation and cardiac index) were individually tested in models. RESULTS: 59 out of 874 patients developed intestinal ischemia. A mean oxygen delivery less than 250ml/min/m(2) (LRT vs. null model: p = 0.018; LRT for non-linearity: p = 0.012) as well as a minimum oxygen delivery less than 400ml/min/m(2) (LRT vs null model: p = 0.016; LRT for linearity: p = 0.019) were associated with increased risk of the development of intestinal ischemia. We found no significant influence of hemoglobin, arterial oxygen saturation, cardiac index or systemic vascular resistance index. Receiver operating characteristics analysis for elevated lactate levels, pH, CO(2) and central venous saturation was poor with an area under the receiver operating characteristic of 0.5324, 0.52, 0.6017 and 0.6786. CONCLUSION: There was a significant correlation for mean and minimum oxygen delivery with the incidence of intestinal ischemia for values below 250ml/min/m(2) respectively 400ml/min/m(2). Neither hemoglobin, arterial oxygen saturation, cardiac index, systemic vascular resistance index nor elevated lactate levels could be identified as individual risk factors. Public Library of Science 2021-07-09 /pmc/articles/PMC8270469/ /pubmed/34242347 http://dx.doi.org/10.1371/journal.pone.0254352 Text en © 2021 Schoettler et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Schoettler, Jochen J. Kirschning, Thomas Hagmann, Michael Hahn, Bianka Fairley, Anna-Meagan Centner, Franz-Simon Schneider-Lindner, Verena Herrle, Florian Tzatzarakis, Emmanouil Thiel, Manfred Krebs, Joerg Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients |
title | Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients |
title_full | Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients |
title_fullStr | Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients |
title_full_unstemmed | Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients |
title_short | Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients |
title_sort | maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270469/ https://www.ncbi.nlm.nih.gov/pubmed/34242347 http://dx.doi.org/10.1371/journal.pone.0254352 |
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