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Intra-abdominal hypertension: exploration of early changes in intra-abdominal metabolism in a porcine model
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. 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.
Department of Surgery Örebro University Hospital, Örebro, Sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To investigate the early effects of intra-abdominal hypertension on intraabdominal metabolism and intestinal mucosal blood flow.

Design: Prospective animal study.

Setting: University hospital research laboratory.

Subjects: Three-month old domestic pigs of both sexes.

Interventions: The animals were anesthetized and ventilated. Fifteen animals were subjected to intra-abdominal hypertension of 30 mmHg for four hours by carbon dioxide insufflation. Seven animals served as controls.

Measurements and Main Results: Hemodynamic data, arterial blood samples and urine output were analyzed. Intraluminal laserdoppler flowmetry measured intestinal mucosal blood flow. Glucose, glycerol, lactate and pyruvate concentrations and lactate-pyruvate (l/p) ratio were measured intraperitoneally and intramurally in the small intestine and rectum by microdialysis. Intra-abdominal hypertension lowered the abdominal perfusion pressure by 12- 18 mmHg, reduced the intestinal mucosal blood flow by 45-63% and decreased urine output by 50-80%. While controls remained stable, glycerol concentrations increased at all locations at elevated intra-abdominal pressure, .pyruvate concentrations decreased and the l/p ratio increased intraperitoneally and intramurally in the small intestine. Glucose and lactate concentrations at all locations were only slightly affected or unchanged in both groups.

Conclusions: Intra-abdominal hypertension negatively influences intestinal blood flow and diuresis and causes early metabolic changes, indicating a discrete shift towards anaerobic metabolism. Metabolic changes, measured by intra-abdominal microdialysis, preferably by an intraperitoneal catheter, might be used as early markers of impaired visceral organ function in intra-abdominal hypertension and abdominal compartment syndrome.

Keywords [en]
intra-abdominal hypertension; microdialysis; laserdoppler flowmetry; lactate;pyruvate; glycerol
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-34965OAI: oai:DiVA.org:oru-34965DiVA, id: diva2:715525
Available from: 2014-05-05 Created: 2014-05-05 Last updated: 2017-10-17Bibliographically 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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