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Abdominal Hypertension and Decompression: The Effect on Peritoneal Metabolism in an Experimental Porcine Study
Department 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. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
Orebro Univ Hosp, Dept Surg, SE-70185 Orebro, Sweden.
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2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: This study aims to investigate the abdominal metabolic response and circulatory changes after decompression of intra-abdominal hypertension in a porcine model. Design: Prospective study with controls. Setting: University hospital research laboratory.

Subjects: Three-months old domestic pigs of both sexes. Interventions: The animals were anesthetised and ventilated. Nine animals had a pneumoperitoneum-induced intra-abdominal hypertension of 30 mmHg for six hours. Twelve animals had corresponding intra-abdominal hypertension for four hours followed by decompression and were monitored for another two hours.

Measurements and Main Results: Hemodynamics, urine output and arterial blood samples were analysed. Laserdoppler measured mucosal blood flow and urine output decreased with pressure induction and showed a statistically significant restitution after decompression. Glucose, glycerol, lactate and pyruvate concentrations and lactate-pyruvate (l/p) ratio were measured by microdialysis. Both groups developed distinct metabolic changes intraperitoneally at pressure induction including an increased l/p ratio as signs of organ hypoperfusion. In the decompression group the intraperitoneal l/p ratio normalised during the second decompression hour, indicating partially restored perfusion.

Conclusions: Decompression after four hours of intra-abdominal hypertension results in restoration of intestinal blood flow and normalised intraperitoneal metabolism.

Place, publisher, year, edition, pages
2014. Vol. 47, no 4, p. 402-410
Keywords [en]
Glycerol, Intra-abdominal hypertension, Lactate, Laser Doppler flowmetry, Microdialysis, Pyruvate
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-34963OAI: oai:DiVA.org:oru-34963DiVA, id: diva2:715487
Available from: 2014-05-05 Created: 2014-05-05 Last updated: 2017-10-18Bibliographically 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, LarsLarzon, Thomas

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