Acute Cardiovascular and Hematologic Changes After a Single Transfusion Demonstrate Sex Differences in Chronically Transfused Sickle Cell Anemia Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2138-2138
Author(s):  
Jon Detterich ◽  
Roberta Miyeko Kato ◽  
Ani Dongelyan ◽  
Adam Bush ◽  
Herbert J. Meiselman ◽  
...  
Keyword(s):  
Platelet Count ◽  
Cardiac Index ◽  
Vascular Resistance ◽  
Carrying Capacity ◽  
Oxygen Delivery ◽  
Reticulocyte Count ◽  
Free Hemoglobin ◽  
Hemoglobin S ◽  
Oxygen Carrying Capacity

Abstract Abstract 2138 Chronic transfusion therapy (CTT) is a mainstay for stroke prophylaxis in sickle cell anemia. Long-term changes with transfusion include decreased hemoglobin S% and hemolysis resulting in decreased plasma free hemoglobin. Long-term benefits are well documented, however, patients on CTT continue to suffer from acute crises. The acute effects of each transfusion are not well known but might include improved oxygen carrying capacity secondary to increased hematocrit, reducing demands for high cardiac output. But, the increased hematocrit and oxygen carrying capacity is at the cost of increased viscosity and resistance to blood flow. Despite long-term benefits, acute complications continue to plague this patient population and could be due to acute rheologic changes with transfusion. We hypothesized that transfusion would acutely improve tissue oxygen delivery despite increasing blood viscosity and vascular resistance. To test this hypothesis, we prospectively examined patients on CTT immediately pre transfusion and again 12–120 hours post transfusion. Hemodynamics were tested by measuring blood pressure, heart rate and cardiac function by echocardiography. Tissue oxygen delivery was assessed using echocardiographic estimates of cardiac output, pulse oximetry and oxygen carrying capacity as well as near infrared spectroscopy (NIRS). We obtained basic hematology and metabolic labs in addition to markers of inflammation, hemolysis and amino acid profile at both visits. Male and female patients were equally represented with similar average age. The reasons for starting transfusion as well as medication profiles were similar between sexes. Comparable changes in hemoglobin, hematocrit, reticulocyte count and hemoglobin S with transfusion were observed in all patients. However, when pre transfusion levels of free hemoglobin, hemoglobin S%, platelet count and reticulocyte count were examined with regard to timing from the previous transfusion, males had faster recovery of endogenous marrow activity and increased hemolysis, producing higher average hemoglobin S%, reticulocyte count, platelet count and free hemoglobin levels (figure 1). In males, transfusion decreased heart rate, stroke volume, and cardiac index while estimates for pulmonary and systemic vascular resistance rose, culminating in decreased oxygen delivery. In contrast, stroke volume and cardiac index were preserved in women following transfusion, while systemic and pulmonary vascular resistance did not change such that oxygen delivery improved 16%. NIRS measurements assessing tissue oxygenation confirmed the differences seen using echocardiography and oxygen carrying capacity estimates(figure 2).Figure 1Figure 1. Figure 2Figure 2. Increased endogenous marrow activity in males, resulting in higher pre-transfusion reticulocyte count, hemoglobin S%, platelet count and free hemoglobin might account for the exaggerated reduction in cardiac index, as well as increased systemic and pulmonary vascular resistance with transfusion. In addition, the faster recovery of hemoglobin S% and hemolysis likely confers increased risk of vascular complications in male patients despite chronic transfusion therapy. Disclosures: Wood: Novartis: Research Funding; Ferrokin Biosciences: Consultancy; Cooleys Anemia Foundation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Acute Hemodynamic and Vascular Effects of Transfusion in Chronically Transfused Patients with Sickle Cell Anemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1516-1516
Author(s):  
Jon A Detterich ◽  
Suvimol Sangkatumvong ◽  
Roberta Kato ◽  
Michael Khoo ◽  
Thomas Coates ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Vascular Resistance ◽  
Sickle Cell Anemia ◽  
Blood Viscosity ◽  
Oxygen Delivery ◽  
Reticulocyte Count ◽  
Tissue Oxygen ◽  
Transfusion Therapy ◽  
Shear Rates ◽  
Tissue Oxygen Delivery

Abstract Abstract 1516 Poster Board I-539 Introduction Patients with sickle cell anemia (SCA) who are at risk for stroke or develop recurrent episodes of acute chest are often placed on chronic transfusion therapy. The acute hemodynamic and vascular consequences of transfusion are poorly characterized. In order to better characterize chronic changes in these patients, it is important to understand the acute changes involved with this intervention. Methods We enrolled SCA patients who are on chronic transfusion therapy in a prospective study to determine the cardiovascular effects of a single transfusion. The patients were older than 10 years of age, received chronic transfusions for greater than one year, and were crisis free for more than four weeks. All patients were studied immediately prior to transfusion and repeated within five days. Brachial artery relaxivity, laser doppler capillary blood flow monitoring, and near infrared spectroscopy of the hand was done in the setting of post occlusive reactive hyperemia. Studies included complete cardiac echocardiogram as well as laboratory markers of hemolysis, iron levels, blood count, viscosity and inflammation were obtained pre and post transfusion. Statistics utilized paired t-tests for paired data and for correlative data t-tests and chi square analysis was used. Results There are 15 patients enrolled in the study with an average age of 18.7yrs. There are 8 females and 7 males with average ages of 20.6 and 16.4 yrs respectively. With transfusion, hemoglobin increased from 9.4 g/dl to 11.6 g/dl post (p<0.0001), reticulocyte count decreased from 12.4% to 7.8% (p=0.0019) and HbS% decreased from 38.2% to 31.5% (p=0.0001). Markers of hemolysis (LDH, Plasma Free Hemoglobin, Arg/Orn Ratio) do not differ significantly pre and post transfusion. Cardiac index decreased from 5.4L/min/m2 to 4.1 L/min/m2 (p=0.0012), resulting from decreased stroke volume (70.8ml to 58.9ml, p=0.0119) and lower heart rate (84 to 78bpm, p=0.0098). Systolic and diastolic function metrics were unchanged, as was estimates of pulmonary artery pressure. Blood pressure was unchanged, indicating that the change in cardiac output was matched by parallel changes in total vascular resistance. Endothelial function and regional vascular reactivity assessed using laser Doppler capillary flow analysis demonstrated no significant change in hyperemic response pre and post transfusion. Blood viscosity increased with transfusion in a shear-rate dependent manner, for low shear rates the viscosity increased an average of 62% using fully oxygenated samples and at higher shear rates the viscosity increased an average of 25% using fully oxygenated samples. Discussion Transfusion therapy predictably increased oxygen carrying capacity, lowered reticulocyte count and %hemoglobin S. While these changes might improve tissue oxygen delivery, parallel changes in vascular resistance served to maintain relatively constant oxygen delivery. The rise in vascular resistance could result from increased blood viscosity or changes in vascular tone; we are currently conducting studies to try to separate these mechanisms. Despite the 24% reduction in cardiac index, no significant change was observed in microvascular perfusion or its response to forearm occlusion. The vascular system of SCA patients demonstrates chronic endothelial dysfunction but was not acutely influenced by transfusions, consistent with the lack of acute improvement in surrogates for hemolysis or nitric oxide metabolism. Further work is necessary to determine whether transfusion-mediated changes in tissue oxygen delivery vary among different organs and vascular beds. Disclosures Wood: Novartis: Research Funding.

scholarly journals EVALUATION OF A STROMA-FREE HEMOGLOBIN SOLUTION FOR USE AS A PLASMA EXPANDER

1967 ◽  
Vol 126 (6) ◽  
pp. 1127-1142 ◽  
Author(s):  
S. Frederick Rabiner ◽  
J. Raymond Helbert ◽  
Harry Lopas ◽  
Lila H. Friedman
Keyword(s):  
Carrying Capacity ◽  
Vital Signs ◽  
Free Hemoglobin ◽  
Hemoglobin Solution ◽  
Plasma Expander ◽  
Chronic Effects ◽  
Coagulant Activity ◽  
Methemoglobin Formation ◽  
Oxygen Carrying Capacity ◽  
Acute And Chronic Effects

The preparation of large quantities of a stable, stroma-free hemoglobin solution without coagulant activity is described. Following infusion of this solution into phlebotomized dogs, there is no methemoglobin formation, no adverse effects on vital signs, and no demonstrable activation of blood coagulation. The hemoglobin maintains its oxygen-carrying capacity and liberates oxygen into tissues. Acute and chronic effects on renal function following infusion of this preparation were also studied and no effect on clearance of urea, creatinine, or P.A.H. could be demonstrated. There was no change in urinary output and histological sections revealed no lesions attributable to hemoglobin toxicity. It is concluded that a stroma-free hemoglobin solution may have use as a plasma expander.

scholarly journals Reduction of Oxygen-Carrying Capacity Weakens the Effects of Increased Plasma Viscosity on Cardiac Performance in Anesthetized Hemodilution Model

2012 ◽  
Vol 2012 ◽  
pp. 1-9
Author(s):  
Surapong Chatpun ◽  
Pedro Cabrales
Keyword(s):  
Cardiac Output ◽  
Carrying Capacity ◽  
Oxygen Delivery ◽  
Maximum Rate ◽  
Systolic Pressure ◽  
Pressure Change ◽  
Plasma Viscosity ◽  
Cardiac Performance ◽  
Dextran 70 ◽  
Oxygen Carrying Capacity

We investigated the effects of reduced oxygen-carrying capacity on cardiac function during acute hemodilution, while the plasma viscosity was increased in anesthetized animals. Two levels of oxygen-carrying capacity were created by 1-step and 2-step hemodilution in male golden Syrian hamsters. In the 1-step hemodilution (1-HD), 40% of the animals' blood volume (BV) was exchanged with 6% dextran 70 kDa (Dx70) or dextran 2000 kDa (Dx2M). In the 2-step hemodilution (2-HD), 25% of the animals' BV was exchanged with Dx70 followed by 40% BV exchanged with Dx70 or Dx2M after 30 minutes of first hemodilution. Oxygen delivery in the 2-HD group consequently decreased by 17% and 38% compared to that in the 1-HD group hemodiluted with Dx70 and Dx2M, respectively. End-systolic pressure and maximum rate of pressure change in the 2-HD group significantly lowered compared with that in the 1-HD group for both Dx70 and Dx2M. Cardiac output in the 2-HD group hemodiluted with Dx2M was significantly higher compared with that hemodiluted with Dx70. In conclusion, increasing plasma viscosity associated with lowering oxygen-carrying capacity should be considerably balanced to maintain the cardiac performance, especially in the state of anesthesia.

Effects of Venesection on Leg Blood Flow in Claudicants with High-Normal Haematocrit

1988 ◽  
Vol 33 (4) ◽  
pp. 298-299 ◽  
Author(s):  
A.R. Turner ◽  
G.D.O. Lowe ◽  
C.D. Forbes ◽  
J. G. Pollock
Keyword(s):  
Blood Flow ◽  
Intermittent Claudication ◽  
Carrying Capacity ◽  
Blood Viscosity ◽  
Oxygen Delivery ◽  
Peak Flow ◽  
Haemoglobin Concentration ◽  
Leg Blood Flow ◽  
Calf Blood Flow ◽  
Oxygen Carrying Capacity

Patients with intermittent claudication frequently have high-normal levels of haematocrit and hence blood viscosity, which may contribute to decreased calf blood flow on exercise, and hence to the symptom of claudication. Reduction in haematocrit and viscosity by serial venesection in eight patients with stable claudication and high-normal haematocrit (mean 0.50) was performed, and the effects on claudication, calf blood flow, and calf oxygen delivery were studied. Following reduction in haematocrit to low-normal levels (mean 0.44), resting calf blood flow was unchanged; peak flow after ischaemic exercise increased slightly (+17%), but peak oxygen delivery (peak flow × haemoglobin concentration) was unchanged. Hence any increase in calf blood flow in the symptomatic leg is balanced by a decrease in oxygen-carrying capacity after venesection. No increase in claudication time would therefore be expected, and none was observed in the present study.

Stroma-free hemoglobin: its presence in plasma does not improve oxygen supply to the resting hindlimb vascular bed of hemodiluted dogs

1991 ◽  
Vol 69 (11) ◽  
pp. 1656-1662 ◽  
Author(s):  
George P. Biro ◽  
Peter J. Anderson ◽  
Scott E. Curtis ◽  
Stephen M. Cain
Keyword(s):  
Vascular Resistance ◽  
Oxygen Delivery ◽  
Oxygen Supply ◽  
Oxygen Extraction ◽  
Free Hemoglobin ◽  
Hemoglobin Solution ◽  
Arterial Blood ◽  
Vascular Bed ◽  
Critical Oxygen ◽  
Plasma Phase

In hemodilution, red cell spacing in the microcirculation is increased, flow distribution may become more heterogeneous, and, as a result, oxygen supply to tissues may suffer. We tested the hypothesis that oxygen extraction from diluted blood may be enhanced by the presence of hemoglobin in the plasma phase in relatively low concentrations. In anesthetized dogs, the hindlimb vascular bed was isolated and perfused with the animal's own blood by a roller pump. One group of dogs (n = 6) was hemodiluted (hematocrit = 15.0 ± 1.0%) with a 6% solution of dextran. A second group of dogs (n = 6) was similarly hemodiluted (hematocrit = 16.0 ± 0.4%) with dextran containing stroma-free hemoglobin solution whereby plasma-phase hemoglobin concentration was raised to 1.1 ± 0.1 g∙dLé−1. Systemic hemodynamic observations were made repeatedly over the subsequent 2.5 h, while blood flow to the hindlimb was progressively reduced in stepwise decrements. The hemoglobin-hemodiluted group showed increased systemic arterial blood pressure and total peripheral resistance when compared with the control (dextran diluted) group. The isolated hindlimb also showed evidence of increased vascular resistance in the hemoglobin-treated group. In each individual animal, critical oxygen delivery and extraction were determined by finding the intercept of the supply-independent and supply-dependent portions of the oxygen uptake/oxygen delivery relationship. Neither the critical oxygen delivery rates (5.75 ± 0.83 vs. 6.41 ± 0.53 mL∙kg−1 min−1) nor critical oxygen extraction ratios (0.75 ± 0.03 vs. 0.76 ± 0.04) were found to be significantly different in the two groups. We conclude that hemoglobin in solution in the plasma at a concentration of about 1 g∙dL−1 induces significant increase in vascular resistance and fails to augment oxygen extraction from diluted blood by the resting hindlimb.Key words: stroma-free hemoglobin solution, oxygen extraction, vasoconstriction, isolated hindlimb vascular bed, oxygen supply.

scholarly journals Differentiated approach to treatment of arterial hypertension in patients, suffering ischemic cerebral stroke

2020 ◽  
Vol 87 (1-2) ◽  
pp. 47-52
Author(s):  
K. V. Serikov ◽  
L. M. Smyrnova ◽  
O. F. Dzygal
Keyword(s):  
Cardiac Index ◽  
Arterial Hypertension ◽  
Vascular Resistance ◽  
Antihypertensive Therapy ◽  
Oxygen Delivery ◽  
Peripheral Vascular Resistance ◽  
Cerebral Stroke ◽  
Middle Grade ◽  
Peripheral Vascular ◽  
Arterial Blood

Objective. To raise the efficacy of treatment of arterial hypertension in patients, suffering ischemic cerebral stroke of the middle grade of severity on background of determination of hemodynamic variant of arterial hypertension. Materials and methods. Prospective nonrandomized investigation concerning 42 patients, suffering ischemic cerebral stroke of middle severity in accordance to the insult severity scale of National Institute of Health (National Institutes of Health Stroke Scale - NIHSS), was conducted. The patients’ middle age have constituted (69.4 ± 1.4) yrs. There were the central hemodynamic indices measured, the arterial hypertension hemodynamic variant determined, the oxygen and hemodynamic status estimated, and in accordance to the results obtained - the differentiated antihypertensive therapy was administered. All the patients were divided into three groups, depending on hemodynamical variant of arterial hypertension: the first group – patients with eukinetic variant, the second group – patients with hypokinetic variant, the third group – patients with hyperkinetic variant. Hemodynamical variant of arterial hypertension was determined in accordance to the referent level of cardiac index. The groups were representative in accordance to age, height, the body mass, the main and concurrent pathology and the cerebral affection degree. Results. In the patients, suffering initial eukinetic hemodynamical variant of arterial hypertension, the cardiac index have fluctuated from 2.88 to 4.67 l × min-1 × m-2, general peripheral vascular resistance have rested in the norm borders, the oxygen saturation level of arterial blood did not demand the oxygen therapy, index of the oxygen delivery have exceeded the appropriate values and fluctuated in borders from 541 to 903 l × min-1 × m-2. In complex of differentiated antihypertensive therapy there was applied a constant intravenous injection of magnesium sulfate in a daily dose 2500 - 5000 mg. For patients with initial hypokinetic hemodynamic variant of arterial hypertension following signs are characteristic: low cardiac index - from 1.65 to 2.08 l × min-1 × m-2, the enhanced general peripheral vascular resistance - 2813 (from 2393 to 3403) dyne × s-1 × cm-5 and the lowered index of the oxygen delivery - from 306 to 412 l × min-1 × m-2. Differentiated antihypertensive therapy was conducted, using urapidyl: intravenous boluses 1.25 – 2.5 mg with further infusion 5 - 40 mg × h-1. For hyperkinetic hemodynamic variant of arterial hypertension the raised cardiac index is characteristic – 3.75 l × min-1 × m-2 (fluctuated in borders from 3.62 to 4.10 l × min-1 × m-2), as well as normal general peripheral vascular resistance - 1189 (from 1055 to 1449) dyne × s-1 × cm-5 and raised index of the oxygen delivery - 762 (from 725 to 828) l × min-1 × m-2. Differentiated antihypertensive therapy was conducted, using labetalol: intravenous infusion with velocity 2 - 8 mg × min-1. Conclusion. In the patients with ischemic cerebral stroke of the middle grade of severity the conduction of differentiated antihypertensive therapy, taking into account hemodynamic type of arterial hypertension and the oxygen-hemodynamic stabilization of the blood circulation system, improved the results of treatment and accelerated the rehabilitation duration.

Seasonal variation in body mass and blood oxygen carrying capacity of the superb fairy-wren (Malurus cyaneus)

2002 ◽  
Vol 50 (3) ◽  
pp. 313 ◽  
Author(s):  
J. Box ◽  
A. Lill ◽  
J. Baldwin
Keyword(s):  
Body Mass ◽  
Carrying Capacity ◽  
Oxygen Delivery ◽  
Blood Oxygen ◽  
Additional Energy ◽  
Blood Haemoglobin ◽  
Malurus Cyaneus ◽  
Energy Challenge ◽  
Oxygen Carrying Capacity ◽  
Winter Fattening

The responses of small birds to many seasonal energy challenges include enhancement of aspects of aerobic metabolism, sometimes involving an increase in the rate of oxygen delivery to the metabolising tissues. One such mechanism that enhances oxygen delivery seasonally is an increase in blood oxygen carrying capacity. This response is enhanced in birds because of their rapid erythrocyte turnover rate. Some small birds have also evolved winter fattening, which helps them to meet the energy challenge presented by winter conditions. Such adaptations, while well documented for North Temperate birds, have received little attention in birds inhabiting temperate Australia. Over a two-year period, we examined seasonal changes in mass, an approximate indicator of fattening, and the parameters determining blood oxygen carrying capacity in a population of superb fairy-wrens (Malurus cyaneus) in outer Melbourne, Australia. Body mass did not vary significantly seasonally, but haematocrit and whole blood haemoglobin were significantly higher in the breeding season than at other times of year and the erythrocyte count was significantly higher in spring than in autumn. We conclude that the failure of the fairy-wrens to increase mass in winter (i.e. show marked winter fattening) was probably due to the comparative mildness of the climate and to the known fitness costs of fat storage. The significant 18% increase in blood oxygen carrying capacity in spring probably helped the birds to meet the additional energy requirements of breeding, particularly the likely increase in flight activity. However, given the magnitude of the increase, other mechanisms must have been involved in meeting breeding costs. The seasonal peak in blood oxygen carrying capacity did not coincide with the time when moulting was most pronounced.

Effects of acute prolonged hypoxia on cardiovascular dynamics in dogs

1977 ◽  
Vol 43 (5) ◽  
pp. 784-789 ◽  
Author(s):  
J. F. Borgia ◽  
S. M. Horvath
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Cardiac Index ◽  
Carrying Capacity ◽  
Hemoglobin Concentration ◽  
Severe Hypoxia ◽  
Systemic Hypertension ◽  
Anesthetized Dogs ◽  
Oxygen Tensions ◽  
Oxygen Carrying Capacity

Intact anesthetized dogs were exposed for 75 min to either 5.75, 9.0, or 12.0% oxygen in nitrogen. Although pulmonary artery pressures were significantly elevated in all hypoxic exposures, systemic hypertension occurred only at the onset of severe hypoxia(5.75% O2). Coronary blood flow increased from an average of 130 during normoxia to a peak of 400 ml/100 g per min during inhalation of 5.75% O2, and coronary sinus oxygen tensions of 8 Torr and oxygen contents of 1.1 ml/100 ml were sustained for 75 min without biochemical, functional, or electrophysiological evidence of myocardial ischemia. Cardiac index (CI) increased significantly only during severe hypoxia (5.75% O2) with the greatest elevation after 30 min. Subsequently, CI decreased concomitantly with a 27% elevation in arterial hemoglobin concentration and oxygen-carrying capacity. It is concluded that the hypoxic threshold for significant elevations of cardiac output is between 6.0 and 9.0% O2.

scholarly journals The pathophysiology and clinical relevance of platelet heterogeneity

Blood ◽  
1988 ◽  
Vol 72 (1) ◽  
pp. 1-8 ◽  
Author(s):  
CB Thompson ◽  
JA Jakubowski
Keyword(s):  
Platelet Count ◽  
Carrying Capacity ◽  
Clinical Tests ◽  
Platelet Production ◽  
Platelet Size ◽  
Clinical Investigations ◽  
Oxygen Carrying Capacity ◽  
Clinical Problems ◽  
Platelet Physiology ◽  
Platelet Mass

Abstract Recent studies on platelet heterogeneity support the hypothesis that platelet production is regulated to maintain a constant functional platelet mass. In concept this form of regulation is analogous to the manner by which RBC production is controlled to maintain the oxygen- carrying capacity of blood. The platelet mass appears to correlate more closely with platelet function than the platelet count alone, since several factors in addition to the platelet count have been shown to influence the platelets' hemostatic function. These factors include platelet size, density, age, and previous hemostatic interactions. Application of these concepts to clinical problems has provided important insights into platelet physiology and reactivity. Failure to account for differences in platelet heterogeneity among individuals may introduce significant errors in the interpretation of data from laboratory and clinical investigations. However, despite advances, a number of practical issues remain to be resolved before measurements of platelet heterogeneity become accepted as routine clinical tests and are used in the diagnosis of pathologic states.

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

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254352
Author(s):  
Jochen J. Schoettler ◽  
Thomas Kirschning ◽  
Michael Hagmann ◽  
Bianka Hahn ◽  
Anna-Meagan Fairley ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Oxygen Saturation ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Oxygen Delivery ◽  
Intestinal Ischemia ◽  
Arterial Oxygen Saturation ◽  
Resistance Index ◽  
Arterial Oxygen ◽  
Systemic Vascular Resistance Index

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/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. Conclusion 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.

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