Intestinal Oxygenotherapy of Critical Conditions

• Main Authors: V. A. Mazurok, A. S. Golovkin, I. I. Gorelov, A. E. Bautin, I. N. Menshugin, O. A. Slivin, D. S. Tarnovskaya, V. V. Ivanov, V. G. Nikiforov, K. A. Morozov, A. O. Marichev
• Format: Article
• Language: Russian
• Published: Russian Academy of Medical Sciences 2017-12-01
• Series: Obŝaâ Reanimatologiâ
• Subjects: intestinal oxygenotherapy; enteropathy of critical states; citrulline; i-fabp
• Online Access: https://www.reanimatology.com/rmt/article/view/1620
• ISSN: 1813-9779; 2411-7110

The latent or mist diagnosed dysfunction of the small intestine is a common disorder in critically ill patients. Intestinal oxygenotherapy is one of the alternative ways to normalize the coordinated activity of the smooth muscles of the digestive tract.Purpose of the study. To determine the effect of intestinal oxygenotherapy in patients with enteropathies of critical conditions on the dynamics of biomarkers of the intestinal wall permeability and ischemia.Materials and methods. An open prospective descriptive study of 12 critically ill patients (7 adults, 5 children) with multiple organ failure and evident or saspected dysfunction of the gastrointestinal tract. Pediatric patients included children with congenital heart disease who underwent open-heart surgery for the purpose of radical or palliative correction.Results. Complications related to the intestinal oxygenotherapy were not observed. On the contrary, its use in children coincided with the positive clinical dynamics: elimination of intestinal paresis, normalization of digestion of enteral nutrition. However, it is difficult to interpret the results unambiguously. Serum citrulline concentration in children is an objective marker of the functional state of the gastrointestinal tract: in the vast majority of the control points its level was <20 μmol/l; it means a very severe intestinal damage. Serum I-FABP concentration was<100 pg/ml in a significant number of control points, which, by contrast, does not allow to talk about the intestinal wall severe ischemic disturbances. In adults, the initial serum citrulline concentration was <20 μmol/l in the vast majority of control points; but by days 5—6 after the onset of intestinal oxygenation, in the majority of patients the citrulline levels exceeded >20 μmol/l (up to 80 μmol/l). No correlation between serum citrulline and I-FABP concentrations in adults was found.Conclusion. Intestinal oxygenotherapy is a promising therapeutic technique for prevention and correction of enteropathies. The method may appear especially effective in treatment of anaerobic (i.e. Cl. defficile-assosiated colitis) infection. The diagnostic value of plasma citrulline and I-FABP concentrations needs further confirmation.