Hypercapnia (HC) increases systemic oxygen delivery (DO2) and gastric mucosal oxygenation. However, it activates the renin–angiotensin–aldosterone system (RAAS), which conversely reduces mesenteric perfusion. The aims of this study were to evaluate the effect of RAAS inhibition during normocapnia and HC on oral and gastric mucosal oxygenation (μHbO2) and to assess the effect of blood pressure under these circumstances. Five dogs were repeatedly anesthetized to study the effects of ACE inhibition (ACE-I; 5 mg/kg captopril, followed by 0.25 mg/kg per h) on μHbO2 (reflectance spectrophotometry) and hemodynamic variables during normocapnia (end-tidal CO2=35 mmHg) and HC (end-expiratory carbon dioxide (etCO2)=70 mmHg). In the control group, the dogs were subjected to HC alone. To exclude the effects of reduced blood pressure, in one group, blood pressure was maintained at baseline values via titrated phenylephrine (PHE) infusion during HC and additional captopril infusion. ACE-I strongly reduced gastric μHbO2 from 72±2 to 65±2% and mean arterial pressure (MAP) from 64±2 to 48±4 mmHg, while DO2 remained unchanged. This effect was counteracted in the presence of HC, which increased gastric μHbO2 from 73±3 to 79±6% and DO2 from 15±2 to 22±4 ml/kg per min during ACE-I without differences during HC alone. However, MAP decreased similar to that observed during ACE-I alone from 66±3 to 47±5 mmHg, while left ventricular contractility (dPmax) increased from 492±63 to 758±119 mmHg/s. Titrated infusion of PHE had no additional effects on μHbO2. In summary, our data suggest that RAAS inhibition reduces gastric mucosal oxygenation in healthy dogs. HC not only abolishes this effect, but also increases μHbO2, DO2, and dPmax. The increase in μHbO2 during ACE-I under HC is in accordance with our results independent of blood pressure.
Christian Vollmer, Ingo Schwartges, Robert Behmke, Inge Bauer and Olaf Picker
Christian Vollmer, Ingo Schwartges, Silke Naber, Christopher Beck, Inge Bauer and Olaf Picker
Hypercapnia (HC) improves systemic oxygen delivery (DO2) and microvascular hemoglobin oxygenation of the mucosa (μHbO2). Simultaneously, HC increases plasma levels of vasopressin. Although vasopressin is generally regarded a potent vasoconstrictor particularly in the splanchnic region, its effects on splanchnic microcirculation during HC is unclear. The aim of this study was to evaluate the role of endogenous vasopressin on gastric mucosal oxygenation and hemodynamic variables during physiological (normocapnia) and hypercapnic conditions. Five dogs were repeatedly anesthetized to study the effect of vasopressin V1A receptor blockade ([Pmp1,Tyr(Me)2]-Arg8-Vasopressin, 35 μg/kg) on hemodynamic variables and μHbO2 during normocapnia or HC (end-tidal CO2 70 mmHg). In a control group, animals were subjected to HC alone. μHbO2 was measured by reflectance spectrophotometry, systemic DO2 was calculated from intermittent blood gas analysis, and cardiac output was measured by transpulmonary thermodilution. Data are presented as mean±s.e.m. for n=5 animals. During HC alone, DO2 increased from 12±1 to 16±1 ml/kg per min and μHbO2 from 70±4 to 80±2%. By contrast, additional vasopressin V1A receptor blockade abolished the increase in μHbO2 (80±2 vs 69±2%) without altering the increase in DO2 (16±1 vs 19±2 ml/kg per min). Vasopressin V1A receptor blockade (VB) during normocapnia neither affected DO2 (13±1 vs 14±1 ml/kg per min) nor μHbO2 (75±3 vs 71±5%). Vasopressin V1A receptor blockade abolished the increase in μHbO2 during HC independent of DO2. Thus, in contrast to its generally vasoconstrictive properties, the vasopressin V1A receptors seem to mediate the increase in gastric microcirculatory mucosal oxygenation induced by acute HC.