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Assessment of cerebral and renal autoregulation using near-infrared spectroscopy under normal, hypovolaemic and postfluid resuscitation conditions in a swine model: An observational study.

Abstract：

BACKGROUND:The impact of blood pressure changes on tissue oxygenation differs between vital organs and with blood volume conditions. OBJECTIVE:To assess cerebral and renal autoregulation simultaneously and compare the impact of blood pressure, hypovolaemia and fluid resuscitation on tissue oxygenation using near-infrared spectroscopy. DESIGN:Animal observational study. SETTING:An animal laboratory in Hamamatsu University School of Medicine, Hamamatsu, Japan, from April 2018 to August 2018. ANIMALS:Fifteen pigs, (mean ± SD) 25.2 ± 0.4 kg. INTERVENTIONS:The pigs were anaesthetised with 2.5% isoflurane and phenylephrine 0.5, 1, 2 and 5 μg kg min was administered in a stepwise fashion at 10-min intervals (baseline), followed by similar administration of sodium nitroprusside. Hypovolaemia was induced by a 600-ml bleed (33% of estimated total blood volume). Then phenylephrine was administered again (same protocol). Hypovolaemia was reversed by infusion of 600-ml hydroxyethyl starch. Phenylephrine and sodium nitroprusside were then administered again (same protocol). MAIN OUTCOME MEASURES:Average of the relation between mean arterial pressure (MAP) and cerebral or renal tissue oxygenation index (TOI) and individual TOI response during vasoactive drug infusions. RESULTS:The average relationship between MAP and cerebral or renal TOI both showed classic autoregulation patterns, whereas the renal TOI was more pressure-dependent than the cerebral TOI. Hypovolaemia shifted the relationship downward, reducing the cerebral and renal TOIs by approximately 5 and 20%, respectively, at similar MAPs. Subsequent fluid resuscitation preserved the autoregulatory pattern in both organs, not changing cerebral TOI but reducing renal TOI to 10% under baseline. TOI responses in both organs included paradoxical changes (tissue oxygenation changed inversely with MAP) in 60% of animals. Animals with paradoxical reactions maintained more stable cerebral and renal oxygenation. CONCLUSION:Renal oxygenation is more pressure-dependent than pressure-tolerant cerebral oxygenation, and autoregulation is not robust. Renal oxygenation decreased four-fold compared with cerebral oxygenation during hypovolaemia and two-fold during isovolaemic anaemia. Thus, paradoxical responses are part of normal autoregulatory function and beneficial for maintaining stable oxygenation.

journal_name

Eur J Anaesthesiol

journal_title

European journal of anaesthesiology

authors

Kurita T,Kawashima S,Morita K,Nakajima Y

doi

10.1097/EJA.0000000000001021

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

531-540

issue

eissn

0265-0215

issn

1365-2346

pii

00003643-201907000-00009

journal_volume

pub_type

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Assessment of cerebral and renal autoregulation using near-infrared spectroscopy under normal, hypovolaemic and postfluid resuscitation conditions in a swine model: An observational study.