Tissue bioenergetics and microvascular perfusion are impaired in rat ileal mucosa in normotensive sepsis

Objective: Sepsis is a systemic inflammatory response to a bacterial infection. Inflammation may result in injury to the small bowel and an increase in translocation of bacteria and toxins across the mucosal barrier, which may contribute to the progression of sepsis. Microcirculatory perfusion or cytopathic hypoxia may cause impairment of tissue bioenergetics and injury in sepsis. The objective of this study was to determine if sepsis is associated with microcirculatory hypoperfusion and impaired tissue bioenergetics in the ileal mucosa. Materials and Methods: Sprague-Dawley rats were randomized to cecal ligation and perforation ( sepsis group, n = 12) or control group (n = 14) and received arterial and venous catheters and fluid resuscitation. Following 24 h, rats were anesthetized with isoflurane and the ileum was prepared for intravital microscopy. Images of NADH fluorescence, which is an index of tissue bioenergetics, central arterial diameter, red cell velocity, red cell flux, and average intercapillary area, were recorded in 6 - 9 villi in each rat. Results: Central arterial red cell flux ( control 277 +/- 30 cell/s, sepsis 108 +/- 13 cells/s, p<. 05), diameter ( control 10.4 +/- 0.4 mu m, sepsis 8.2 +/- 0.3 mu m, p<. 05) and red cell velocity ( control 590 +/- 47 mu m/ s, sepsis 449 +/- 63 mu m/s, p<. 05) were decreased while average intercapillary area ( control 815 +/- 171 mu m(2), sepsis 1412 +/- 364 mu m(2), p<. 05) and NADH fluorescence ( control 116 +/- 6 AIU, sepsis 154 +/- 9 AIU, p<. 05) were increased at the villus tip in the sepsis group. Conclusion: Sepsis is associated with bioenergetic impairment and capillary hypoperfusion at the villus tip and a decrease in red cell flux in the central arteriole.