Endotoxaemia during left ventricular assist device insertion: relationship between risk factors and outcome.


Journal Article

BACKGROUND:Endotoxaemia, caused by splanchnic ischaemia during surgery, is believed to trigger systemic inflammation and cause postoperative organ dysfunction. A relationship between the plasma concentration of endotoxin during surgery and known risk factors for postoperative morbidity and mortality (e.g. age, abnormal gastric tonometric variables) and adverse outcome after surgery has not been demonstrated. METHODS:In a prospective study, the plasma concentration of endotoxin was measured in 12 patients undergoing implantation of a left ventricular assist device. Automated air gastric tonometry was performed in all patients. The relationship between plasma endotoxin concentration, risk factors, and postoperative outcome was explored. RESULTS:Carbon dioxide gap increased from 0.7 (0.3) to 3.6 (1.6) kPa at the end of surgery. Endotoxin was detected in one of 12 patients at baseline and in nine of 12 patients at the end of surgery (P=0.003). A high plasma concentration of endotoxin at the end of surgery was associated with a higher carbon dioxide gap (r=0.59, P<0.05), and a higher postoperative multiple organ dysfunction score (r=0.7, P=0.01). CONCLUSIONS:The finding of an association between high intraoperative plasma concentrations of endotoxin, abnormal gastric tonometric variables and adverse outcome supports the view that endotoxaemia is caused by gut hypoperfusion during surgery and is associated with postoperative organ dysfunction.

Full Text

Cited Authors

  • O'Malley, CMN; Frumento, RJ; Mets, B; Naka, Y; Bennett-Guerrero, E

Published Date

  • January 2004

Published In

Volume / Issue

  • 92 / 1

Start / End Page

  • 131 - 133

PubMed ID

  • 14665564

Pubmed Central ID

  • 14665564

Electronic International Standard Serial Number (EISSN)

  • 1471-6771

International Standard Serial Number (ISSN)

  • 0007-0912

Digital Object Identifier (DOI)

  • 10.1093/bja/aeh010


  • eng