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Splanchnic and peripheral tissue perfusion in experimental fat embolism

Rautanen, Markku MD; Kuttila, Kari MD; Gullichsen, Eero MD; Perttila, Juha MD; Nelimarkka, Olavi MD; Niinikoski, Juha MD

Laboratory Investigation

Objective  To investigate the acute effects of experimental fat embolism on splanchnic and peripheral perfusion and oxygenation in pigs.

Design  Randomized, controlled trial.

Setting  Animal laboratory.

Subjects  Eighteen domestic pigs, weighing 25 to 31 kg.

Interventions  The 18 pigs were randomized to either the fat embolism or control groups. Nine anesthetized and mechanically ventilated pigs were intracavally infused with a 10% allogeneic bone marrow suspension at a dose of 100 mg/kg over 5 mins (the fat embolism group); nine control pigs received normal saline in the same volume and speed (control group).

Measurements and Main Results  Mean pulmonary arterial pressure, pulmonary vascular resistance, and pulmonary shunt increased, and PaO2 decreased immediately after the bone marrow suspension infusion. In the fat embolism animals, oxygen delivery decreased, oxygen content difference widened, and total oxygen consumption remained high, indicating enhanced oxygen extraction. Further, superior mesenteric artery blood flow and mesenteric oxygen delivery decreased, while intramucosal pH in the small bowel was stable. Subcutaneous PO2 decreased in both groups, whereas transcutaneous PO2 decreased only in the animals receiving bone marrow suspension. Skin red cell flux showed no significant changes.

Conclusions  The present model of fat embolism results in significant impairment in systemic oxygenation. Despite this fact, the intestinal oxygenation remains unaffected probably due to sufficient compensatory mechanisms. Transcutaneous PO2 measurements may provide a useful index for early detection of fat embolism.

(Crit Care Med 1996; 24:1018-1024)

From the Departments of Surgery (Drs. Rautanen, Kuttila, Gullichsen, Nelimarkka, and Niinikoski) and Anesthesiology (Dr. Perttila), and the Cardiorespiratory Research Unit, University of Turku, Turku, Finland.

Supported, in part, by the Turku University Foundation, the Duodecim Foundation, and the Emil Aaltonen Foundation.

Address requests for reprints to: Markku Rautanen, MD, Department of Surgery, University of Turku, FIN-20520 Turku, Finland.

© Williams & Wilkins 1996. All Rights Reserved.