Abstract
Children may develop acute abdominal distension (AAD) following major operations, trauma, or infection, and may have renal dysfunction unrelated to their underlying disease. We studied the effects of AAD alone on central hemodynamics, regional blood flow (BF), and creatinine clearance(CrCl). Six adult mongrel dogs(13-19kg) were anesthetized with alpha-chloralose, volume ventilated, and acutely instrumented to measure heart rate(HR), right atrial (RAP), wedge(PAWP), aortic(AoP), inferior vena caval (IVCP), and abdominal pressures. AAD was accomplished by inflating the abdomen to 20 mmHg with nitrogen. Cardiac index(CI) and BF to heart (H), skeletal muscle(SM), liver(L), and renal cortex(RC) were measured by injecting 15 micron radioactive microspheres into the left ventricle. Measurements were made and urine and blood collected during 30 min pre-inflation and post-deflation control periods and during 60 min of AAD. AAD markedly depressed CI (36%)* without altering HR or AoP. RAP(43%)* and PAWP(27%)* rose, as did pulmonary(63%)* and systemic(66%)* vascular resistances, but left(27%) and right(22%) ventricular stroke-work fell; thus, decreased CI did not result from increased afterload. CI decreased due to impaired myocardial contractility or, if transmural ventricular filling pressures fell with AAD, to decreased preload. L(56%) and RC(32%)* BF fell more than SM(3%) or H(20%) BF. Redistribution of BF was not explained by perfusion pressure changes. Decreased CrCl(84%) results, at least in part, from decreased RC BF. (*p < 0.05 vs. pre-inflation control)
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