Abstract
BackgroundIntra-abdominal hypertension [IAH] occurs frequently among critically ill patients and is associated with increased mortality and organ failure. Two porcine models of IAH that cause abdominal compartment syndrome [ACS] with organ dysfunction were created. We investigated whether the two methods used to create IAH - CO2 pneumoperitoneum or adding volume to the intra-abdominal space - exerted different impacts on the temporal development of organ dysfunction.MethodsTwenty-four 40-kg female pigs were allocated to four groups: 25 mmHg IAH with CO2 pneumoperitoneum (n = 8), >20 mmHg IAH caused by addition of volume (n = 8), and two corresponding sham groups (each n = 4). The two sham groups were later pooled into one control group (n = 8). The animals were monitored for 12 h. Repeated serial measurements were taken of group differences over time and analyzed using analysis of variance.ResultsThirty-eight percent of the animals (n = 3) in each intervention group died near the end of the 12-h experiment. Both intervention groups experienced kidney impairment: increased creatinine concentration (P <0.0001), anuria (P = 0.0005), hyperkalemia (P <0.0001), decreased abdominal perfusion pressure, and decreased dynamic lung compliance. CO2 pneumoperitoneum animals developed hypercapnia (P <0.0001) and acidosis (P <0.0001).ConclusionsBoth methods caused ACS and organ dysfunction within 12 h. Hypercapnia and acidosis developed in the CO2 pneumoperitoneum group.
Highlights
Intra-abdominal hypertension [intra-abdominal hypertension (IAH)] occurs frequently among critically ill patients and is associated with increased mortality and organ failure
After all experiments were performed, we evaluated the data from the group with IAH with CO2 pneumoperitoneum (CO2) sham group and the group with IAH with intra-abdominal volume addition (VOL) sham group at T = 0 h and T = 10 h for the following parameters: weight, diuresis, pH, partial pressure of CO2 [Partial pressure of carbon dioxide (pCO2)], base excess, K+, lactate, heart rate, mean arterial pressure [MAP], mean pulmonary artery pressure [MPAP], central venous pressure [CVP], and creatinine
Baseline values No difference at baseline was observed between the three groups: control (n = 8), CO2 (n = 8), and VOL (n = 8) (Tables 1 and 2)
Summary
Intra-abdominal hypertension [IAH] occurs frequently among critically ill patients and is associated with increased mortality and organ failure. Two porcine models of IAH that cause abdominal compartment syndrome [ACS] with organ dysfunction were created. We investigated whether the two methods used to create IAH - CO2 pneumoperitoneum or adding volume to the intra-abdominal space - exerted different impacts on the temporal development of organ dysfunction. Intra-abdominal hypertension [IAH] occurs frequently among critically ill patients and is both a predictor of MODS [2] and associated with mortality and organ failure [3,4]. Fluid-filled bags placed intra-abdominally were used to simulate IAH [16] Both methods generate IAH and cause ACS, and might produce MODS. The question remains whether there are differences in the effects that the models have on organ dysfunction
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