HYPERTONIC SALINE DEXTRAN FOR CARDIOPULMONARY BYPASS REDUCES GUT TISSUE WATER BUT DOES NOT IMPROVE MUCOSAL PERFUSION/

Gut mucosal ischemia has been associated with cardiopulmonary bypass ( CPB) and may contribute to postoperative systemic inflammatory respons e and multiorgan dysfunction. Hypertonic saline/dextran (HSD) has been previously shown to selectively increase mucosal blood flow in circul atory shock. To determine whether adding HSD to the prime solution for CPB improves gut mucosal blood flow and oxygenation, we performed nor mothermic, non-cross-clamped CPB in pigs with 1 ml/kg of HSD (25% NaCl /24% dextran 70) (HSD group, n = 9) or lactated Ringer's solution (LRS group, n = 9) as control added to a standard prime. Animals were inst rumented with ultrasonic flow probes on the superior mesenteric artery (SMA), laser Doppler mucosal flow probes in the ileum, and indwelling portal vein catheters and tonometers for mucosal hydrogen ion measure ments and pH calculations in the stomach, ileum, and rectum. The total infused volume and net fluid balance was significantly lower in the H SD than in the LRS group (649 +/- 171 ml vs 2075 +/- 385 ml and 502 +/ - 182 ml vs 1891 +/- 363 ml, respectively, P < 0.01). SMA dow in the L RS group increased to 110-123% of baseline during CPB and was signific antly higher than that in the HSD group which remained unchanged. Ilea l mucosal blood flow decreased significantly to 70-50% of baseline in both groups with no difference between groups. Gut oxygen (O-2) delive ry decreased during CPB in both groups, but O-2 consumption remained u nchanged. Gastric, ileal, and rectal mucosal pH decreased progressivel y, and portal venous blood pH also decreased in both groups, but there was no significant difference between groups. The HSD group had 34.5% less water content in the duodenum (P < 0.01), 28.2% less in jejunum, and 18.9% less in colon than the LRS group (P < 0.05). We conclude HS D added to the prime for CPB-reduced volume requirements and gut tissu e water, but did not improve mucosal perfusion or prevent mucosal acid osis. (C) 1994 Academic Press, Inc.