Increased splanchnic oxygen extraction because of routine nursing procedures

Area of Science:

• Critical Care Medicine
• Physiology
• Splanchnic Circulation

Background:

• Multiple organ failure is a frequent complication of acute circulatory and respiratory failure.
• Therapeutic interventions in intensive care units (ICUs) may compromise gut and liver perfusion, increasing oxygen supply-demand mismatch.
• Understanding these impacts is crucial for optimizing patient care and outcomes.

Purpose of the Study:

• To investigate the hypothesis that routine intensive care interventions interfere with splanchnic perfusion.
• To quantify the impact of nursing procedures on hepatic venous oxygen saturation (Sho2).
• To explore the relationship between impaired splanchnic perfusion and organ failure severity.

Main Methods:

• Prospective, observational study in an interdisciplinary university hospital ICU.
• Inclusion of 36 mechanically ventilated patients with acute respiratory/circulatory failure or severe infection.
• Insertion of hepatic venous catheters to monitor hepatic venous oxygen saturation (Sho2).

Main Results:

• Routine nursing procedures, such as airway suctioning and position changes, frequently caused significant decreases in Sho2.
• Procedure-related Sho2 decreases occurred approximately 11 times daily, with a median decrease of 7%.
• Maximal Sequential Organ Failure Assessment scores correlated significantly with the number of Sho2 decreases, indicating a link to organ failure severity.

Conclusions:

• Patients in ICUs are subjected to repeated episodes of impaired splanchnic perfusion during routine nursing care.
• These episodes of hepatic venous desaturation may contribute to the development or worsening of multiple organ failure.
• Further research is necessary to elucidate the precise correlation between nursing procedures and hepatic venous desaturation and its clinical implications.