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Detection of Intestinal Tissue Perfusion by Real-Time Breath Methane Analysis in Rat and Pig Models of Mesenteric Circulatory Distress

Szűcs, Szilárd, MD1; Bari, Gábor, MD1,2; Ugocsai, Melinda, MD1; Lashkarivand, Reza Ali, MD1; Lajkó, Norbert, MD1; Mohácsi, Árpád, PhD3; Szabó, Anna, PhD4; Kaszaki, József, PhD1; Boros, Mihály, MD, PhD, DSc1; Érces, Dániel, MD, PhD1; Varga, Gabriella, PhD1

doi: 10.1097/CCM.0000000000003659
Online Clinical Investigations

Objectives: Methane (CH4) breath test is an established diagnostic method for gastrointestinal functional disorders. Our aim was to explore the possible link between splanchnic circulatory changes and exhaled CH4 in an attempt to recognize intestinal perfusion failure.

Design: Randomized, controlled in vivo animal study.

Setting: University research laboratory.

Subjects: Anesthetized, ventilated Sprague-Dawley rats (280 ± 30 g) and Vietnamese minipigs (31 ± 7 kg).

Interventions: In the first series, CH4 was administered intraluminally into the ileum before 45 minutes mesenteric ischemia or before reperfusion in non-CH4 producer rats to test the appearance of the gas in the exhaled air. In the porcine experiments, the superior mesenteric artery was gradually obstructed during consecutive, 30-minute flow reductions and 30-minute reperfusions achieving complete occlusion after four cycles (n = 6), or nonocclusive mesenteric ischemia was induced by pericardial tamponade (n = 12), which decreased superior mesenteric artery flow from 351 ± 55 to 182 ± 67 mL/min and mean arterial pressure from 96.7 ± 18.2 to 41.5 ± 4.6 mm Hg for 60 minutes.

Measurements and Main Results: Macrohemodynamics were monitored continuously; RBC velocity of the ileal serosa or mucosa was recorded by intravital videomicroscopy. The concentration of exhaled CH4 was measured online simultaneously with high-sensitivity photoacoustic spectroscopy. The intestinal flow changes during the occlusion-reperfusion phases were accompanied by parallel changes in breath CH4 output. Also in cardiac tamponade-induced nonocclusive intestinal ischemia, the superior mesenteric artery flow and RBC velocity correlated significantly with parallel changes in CH4 concentration in the exhaled air (Pearson’s r = 0.669 or r = 0.632, respectively).

Conclusions: we report a combination of in vivo experimental data on a close association of an exhaled endogenous gas with acute mesenteric macro- and microvascular flow changes. Breath CH4 analysis may offer a noninvasive approach to follow the status of the splanchnic circulation.

1Institute of Surgical Research, Faculty of Medicine, University of Szeged, Szeged, Hungary.

2Department of Cardiac Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.

3MTA–SZTE Research Group on Photoacoustic Spectroscopy, Szeged, Hungary.

4Department of Optics and Quantum Electronics, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.

Drs. Szűcs and Bari contributed equally to the article. Drs. Érces and Varga likewise contributed equally to the article.

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Supported, in part, by Hungarian National Research, Development and Innovation Office (NKFIH) grants (NKFIH-K120232 and NKFIH-K116861), as well as GINOP-2.3.2-15-2016-00015, EFOP-3.6.2-16-2017-00006, and 20391-3/2018/FEKUSTRAT.

Dr. Boros’ institution funding from a NKFIH grant. Drs. Érces’ and Varga’s institutions received funding from Hungarian National Research, Development and Innovation Office. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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