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Intra-Abdominal Metabolism and Blood Flow During Abdominal Hypertension: A Porcine Pilot Study Under Intravenous Anaesthesia
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Deparment of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-0934-0063
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Deparment of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
Deparment of Surgery, Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital. Deparment of Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
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2013 (English)In: Archives Of Clinical Experimental Surgery, ISSN 2146-8133, Vol. 2, no 3, p. 176-185Article in journal (Refereed) Published
Abstract [en]

Objective: To study the splanchnic metabolism and intestinal circulation in a porcine model with increased abdominal pressure.

Methods: In an experimental porcine study, performed under intravenous anaesthesia, five animals were subjected to gradually increasing intra-abdominal pressure (15 mmHg, 25 mmHg, and 35 mmHg) with pneumoperitoneum. Microdialysis and laser Doppler were the main outcome methods for monitoring the metabolic and circulatory changes.

Results: During stable anaesthesia and gradually increasing intra-abdominal pressure obtained by CO2-pneumoperitoneum, blood flow (microcirculation) was deprived and moderate signs of impaired splanchnic metabolism were recorded.

Conclusions: The model appears usable for studies of splanchnic metabolic consequences of intra-abdominal hypertension.

Place, publisher, year, edition, pages
Gulhane Military Medical Academy , 2013. Vol. 2, no 3, p. 176-185
Keywords [en]
intra-abdominal hypertension, microdialysis, laser-doppler flowmetry, lactates, pyruvates, glycerol
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-34964DOI: 10.5455/aces.20130118045113OAI: oai:DiVA.org:oru-34964DiVA, id: diva2:715506
Available from: 2014-05-05 Created: 2014-05-05 Last updated: 2019-04-02Bibliographically approved
In thesis
1. On the metabolic consequenses of abdominal compartment syndrome
Open this publication in new window or tab >>On the metabolic consequenses of abdominal compartment syndrome
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Intra-abdominal hypertension (IAH) and the progression to abdominal compartment syndrome (ACS) are known complications of vascular and abdominal surgery, trauma, sepsis, and burns. ACS is associated with high mortality. In ACS, hypoperfusion, hypoxia, onset of inflammatory pathways and increased levels of oxygen reactive species are believed to cause tissue damage and initiate organ failure. Early detection of IAH is central in order to stop the pathological processes. Microdialysis is a method to determine extracellular metabolic changes through analysis of glucose, pyruvate, lactate and glycerol. Microdialysis is known to be feasible in the abdomen to detect early signs of postoperative complications. The ratio of lactate and pyruvate (l/p ratio) reflects the intracellular relationship between aerobic and anaerobic metabolism. Glycerol is elevated when cells have increased energy needs and in cell damage. Our hypothesis was that IAH and ACS cause early metabolic changes in the abdomen which could be determined by microdialysis, and possibly serve as clinical markers for organ failure due to IAH. In Paper I methodology was established using a porcine model with CO2 pneumoperitoneum. Using the model in Paper II and III, we showed that metabolic changes (elevated l/p ratio and glycerol) occurred early in the abdomen as IAH was induced and also restituted after decompression. Decrease in urine output, circulatory changes and impaired mucosal circulation indicated that the model mimicked ACS well. In a clinical study (Paper IV), patients that underwent endovascular surgery for rAAA and later needed decompression due to IAH with organ failure, had more pronounced early metabolic alterations than patients without severe IAH. In conclusion, early abdominal metabolic changes due to IAH are seen experimentally in a model and in patients after rAAA. These changes can be measured with microdialysis and they could, if the results are verified in further studies,be used as clinical markers for IAH and ACS.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 59
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 97
Keywords
intra-abdominal hypertension; intra-abdominal metabolism microdialysis; laserdoppler flowmetry; lactate; pyruvate; glycerol; lactate/pyruvate ratio; ruptured abdominal aortic aneurysm
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-32016 (URN)978-91-7668-976-9 (ISBN)
Public defence
2013-11-29, Wilandersalen, Örebro universitetssjukhus, S Grev Rosengatan, 703 62 Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-10-15 Created: 2013-10-15 Last updated: 2017-10-17Bibliographically approved

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Skoog, PerHörer, Tal M.Norgren, Lars

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Skoog, PerHörer, Tal M.Jansson, KjellNorgren, Lars
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School of Health and Medical Sciences, Örebro University, SwedenÖrebro University HospitalSchool of Humanities, Education and Social Sciences
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