Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model
Abstract Background The gut has been hypothesized to be a protagonist tissue in multiple organ dysfunction syndrome (MODS) for the past three decades. Gastric reactance (XL) is a potential perfusion marker derived from gastric impedance spectroscopy (GIS), which is an emerging tool through which liv...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-11-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40635-022-00476-1 |
| _version_ | 1811217762897362944 |
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| author | María M. Godinez-Garcia Adrian Soto-Mota Jorge Catrip Ruben Gaitan Ma del C. Lespron Francisco J. Molina Miguel A. Falcón Alberto Aranda Carlos A. Tena Pedro Zamudio Ivan Briseño Rolando Alvarez Yazmin Guillen |
| author_facet | María M. Godinez-Garcia Adrian Soto-Mota Jorge Catrip Ruben Gaitan Ma del C. Lespron Francisco J. Molina Miguel A. Falcón Alberto Aranda Carlos A. Tena Pedro Zamudio Ivan Briseño Rolando Alvarez Yazmin Guillen |
| author_sort | María M. Godinez-Garcia |
| collection | DOAJ |
| description | Abstract Background The gut has been hypothesized to be a protagonist tissue in multiple organ dysfunction syndrome (MODS) for the past three decades. Gastric reactance (XL) is a potential perfusion marker derived from gastric impedance spectroscopy (GIS), which is an emerging tool through which living tissue can be continuously measured to determine its pathophysiological evolution. This study aimed to compare the performance of XL [positive predictive values (PPV), negative predictive values (NPV), and area under the curve (AUC)] against commonly used perfusion markers before and during hypovolemic shock in swine subjects. Methods Prospective, controlled animal trial with two groups, control group (CG) N = 5 and shock (MAP ≤ 48 mmHg) group (SG) N = 16. Comparison time points were defined as T-2 (2 h before shock), T-1 (1 h before shock), T0 (shock), T1 (1 h after shock), and T2 (2 h after shock). Shock severity was assessed through blood gases, systemic and hemodynamic variables, and via histological examination for assessing inflammation-edema and detachment in the gastric mucosa. Macroscopic assessment of the gastric mucosa was defined in five levels (0—normal mucosa, 1—stippling or epithelial hemorrhage, 2—pale mucosa, 3—violet mucosa, and 4—marmoreal mucosa). Receiver Operating Characteristic (ROC) curves of perfusion markers and XL were calculated to identify optimal cutoff values and their individual ability to predict hypovolemic shock. Results Comparison among the CG and the SG showed statistically significant differences in XL measurements at T-1, T0, T1, and T2, while lactate showed statistically significant differences until T1 and T2. Statistically significant differences were detected in mucosa class (p < 0.001) and in inflammation-edema in the gastric body and the fundus (p = 0.021 and p = 0.043). The performance of the minimum XL value per subject per event (XL_Min) was better (0.81 ≤ AUC ≤ 0.96, 0.93 ≤ PPV ≤ 1.00, 0.45 ≤ NPV ≤ 0.83) than maximum lactate value (Lac_Max) per subject per event (0.29 ≤ AUC ≤ 0.82, 0.82 ≤ PPV ≤ 0.91, 0.24 ≤ NPV ≤ 0.82). Cutoff values for XL_Min show progressive increases at each time point, while cutoff values for Lac_Max increase only at T2. Conclusions XL proved to be an indirect and consistent marker of inadequate gastric mucosal perfusion, which shows significant and detectable changes before commonly used markers of global perfusion under the hypovolemic shock conditions outlined in this work. |
| first_indexed | 2024-04-12T06:59:53Z |
| format | Article |
| id | doaj.art-fa972f0a6d66483999aacb319acae1e7 |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-04-12T06:59:53Z |
| publishDate | 2022-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-fa972f0a6d66483999aacb319acae1e72022-12-22T03:43:02ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2022-11-0110111610.1186/s40635-022-00476-1Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock modelMaría M. Godinez-Garcia0Adrian Soto-Mota1Jorge Catrip2Ruben Gaitan3Ma del C. Lespron4Francisco J. Molina5Miguel A. Falcón6Alberto Aranda7Carlos A. Tena8Pedro Zamudio9Ivan Briseño10Rolando Alvarez11Yazmin Guillen12Alandra Medical SAPI de CVUnidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” (Spanish Acronym UIEM-INCMNSZ)”Instituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Alandra Medical SAPI de CVInstituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Instituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Instituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Instituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Instituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Instituto Nacional de Enfermedades Respiratorias “Ismael Cossio Villegas” (Spanish Acronym INER)Instituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Instituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Instituto Nacional de Cardiología “Ignacio Chavez” (Spanish Acronym INCICH)Abstract Background The gut has been hypothesized to be a protagonist tissue in multiple organ dysfunction syndrome (MODS) for the past three decades. Gastric reactance (XL) is a potential perfusion marker derived from gastric impedance spectroscopy (GIS), which is an emerging tool through which living tissue can be continuously measured to determine its pathophysiological evolution. This study aimed to compare the performance of XL [positive predictive values (PPV), negative predictive values (NPV), and area under the curve (AUC)] against commonly used perfusion markers before and during hypovolemic shock in swine subjects. Methods Prospective, controlled animal trial with two groups, control group (CG) N = 5 and shock (MAP ≤ 48 mmHg) group (SG) N = 16. Comparison time points were defined as T-2 (2 h before shock), T-1 (1 h before shock), T0 (shock), T1 (1 h after shock), and T2 (2 h after shock). Shock severity was assessed through blood gases, systemic and hemodynamic variables, and via histological examination for assessing inflammation-edema and detachment in the gastric mucosa. Macroscopic assessment of the gastric mucosa was defined in five levels (0—normal mucosa, 1—stippling or epithelial hemorrhage, 2—pale mucosa, 3—violet mucosa, and 4—marmoreal mucosa). Receiver Operating Characteristic (ROC) curves of perfusion markers and XL were calculated to identify optimal cutoff values and their individual ability to predict hypovolemic shock. Results Comparison among the CG and the SG showed statistically significant differences in XL measurements at T-1, T0, T1, and T2, while lactate showed statistically significant differences until T1 and T2. Statistically significant differences were detected in mucosa class (p < 0.001) and in inflammation-edema in the gastric body and the fundus (p = 0.021 and p = 0.043). The performance of the minimum XL value per subject per event (XL_Min) was better (0.81 ≤ AUC ≤ 0.96, 0.93 ≤ PPV ≤ 1.00, 0.45 ≤ NPV ≤ 0.83) than maximum lactate value (Lac_Max) per subject per event (0.29 ≤ AUC ≤ 0.82, 0.82 ≤ PPV ≤ 0.91, 0.24 ≤ NPV ≤ 0.82). Cutoff values for XL_Min show progressive increases at each time point, while cutoff values for Lac_Max increase only at T2. Conclusions XL proved to be an indirect and consistent marker of inadequate gastric mucosal perfusion, which shows significant and detectable changes before commonly used markers of global perfusion under the hypovolemic shock conditions outlined in this work.https://doi.org/10.1186/s40635-022-00476-1Electrical ImpedanceHypovolemic shockGastric reactanceHypoperfusion |
| spellingShingle | María M. Godinez-Garcia Adrian Soto-Mota Jorge Catrip Ruben Gaitan Ma del C. Lespron Francisco J. Molina Miguel A. Falcón Alberto Aranda Carlos A. Tena Pedro Zamudio Ivan Briseño Rolando Alvarez Yazmin Guillen Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model Intensive Care Medicine Experimental Electrical Impedance Hypovolemic shock Gastric reactance Hypoperfusion |
| title | Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model |
| title_full | Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model |
| title_fullStr | Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model |
| title_full_unstemmed | Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model |
| title_short | Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model |
| title_sort | comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model |
| topic | Electrical Impedance Hypovolemic shock Gastric reactance Hypoperfusion |
| url | https://doi.org/10.1186/s40635-022-00476-1 |
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