Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients.

<h4>Background</h4>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 sys...

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Autores principales:	Jochen J Schoettler, Thomas Kirschning, Michael Hagmann, Bianka Hahn, Anna-Meagan Fairley, Franz-Simon Centner, Verena Schneider-Lindner, Florian Herrle, Emmanouil Tzatzarakis, Manfred Thiel, Joerg Krebs
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9516c9eabceb45008338b20855601aeb
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spelling	oai:doaj.org-article:9516c9eabceb45008338b20855601aeb2021-12-02T20:09:18ZMaintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients.1932-620310.1371/journal.pone.0254352https://doaj.org/article/9516c9eabceb45008338b20855601aeb2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254352https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>59 out of 874 patients developed intestinal ischemia. A mean oxygen delivery less than 250ml/min/m2 (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/m2 (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, CO2 and central venous saturation was poor with an area under the receiver operating characteristic of 0.5324, 0.52, 0.6017 and 0.6786.<h4>Conclusion</h4>There was a significant correlation for mean and minimum oxygen delivery with the incidence of intestinal ischemia for values below 250ml/min/m2 respectively 400ml/min/m2. Neither hemoglobin, arterial oxygen saturation, cardiac index, systemic vascular resistance index nor elevated lactate levels could be identified as individual risk factors.Jochen J SchoettlerThomas KirschningMichael HagmannBianka HahnAnna-Meagan FairleyFranz-Simon CentnerVerena Schneider-LindnerFlorian HerrleEmmanouil TzatzarakisManfred ThielJoerg KrebsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254352 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jochen J Schoettler Thomas Kirschning Michael Hagmann Bianka Hahn Anna-Meagan Fairley Franz-Simon Centner Verena Schneider-Lindner Florian Herrle Emmanouil Tzatzarakis Manfred Thiel Joerg Krebs Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>59 out of 874 patients developed intestinal ischemia. A mean oxygen delivery less than 250ml/min/m2 (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/m2 (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, CO2 and central venous saturation was poor with an area under the receiver operating characteristic of 0.5324, 0.52, 0.6017 and 0.6786.<h4>Conclusion</h4>There was a significant correlation for mean and minimum oxygen delivery with the incidence of intestinal ischemia for values below 250ml/min/m2 respectively 400ml/min/m2. Neither hemoglobin, arterial oxygen saturation, cardiac index, systemic vascular resistance index nor elevated lactate levels could be identified as individual risk factors.
format	article
author	Jochen J Schoettler Thomas Kirschning Michael Hagmann Bianka Hahn Anna-Meagan Fairley Franz-Simon Centner Verena Schneider-Lindner Florian Herrle Emmanouil Tzatzarakis Manfred Thiel Joerg Krebs
author_facet	Jochen J Schoettler Thomas Kirschning Michael Hagmann Bianka Hahn Anna-Meagan Fairley Franz-Simon Centner Verena Schneider-Lindner Florian Herrle Emmanouil Tzatzarakis Manfred Thiel Joerg Krebs
author_sort	Jochen J Schoettler
title	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_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_sort	maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/9516c9eabceb45008338b20855601aeb
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Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients.

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