Acute elevation of intra-abdominal pressure contributes to extravascular shift of fluid and proteins in an experimental porcine model

BMC Research Notes

Oddbjørn Haugen¹  Kjell Øvrebø²  Paul Husby¹  Bjørg Elvevoll¹ 

[1] Department of Anesthesia and Intensive Care, Haukeland University Hospital and University of Bergen, N-5021 Bergen, Norway;Department of Surgery, Haukeland University Hospital and University of Bergen, N-5021 Bergen, Norway

关键词: Helium;    Hypo-perfusion;    Protein extravasation;    Fluid extravasation;    Intra-abdominal hypertension;   

Others  :  1127197
DOI  :  10.1186/1756-0500-7-738

 received in 2014-07-13, accepted in 2014-09-24,  发布年份 2014

【 摘 要 】

Background

Intra-abdominal hypertension and abdominal compartment syndrome contribute significantly to increased morbidity and mortality in critically ill patients. This study describes pathophysiologic effects of the acutely elevated intra-abdominal pressure on microvascular fluid exchange and microcirculation. The resulting changes could contribute to development of organ dysfunction or failure.

Methods

16 pigs were randomly allocated to a control-group (C-group) or an interventional group (P-group). After 60 min of stabilization, intra-abdominal pressure of the P-group animals was elevated to 15 mmHg by Helium insufflation and after 120 min to a level of 30 mmHg for two more hours. The C-group animals were observed without insufflation of gas. Laboratory and hemodynamic parameters, plasma volume, plasma colloid osmotic pressure, total tissue water content, tissue perfusion, markers of inflammation and cerebral energy metabolism were measured and net fluid balance and fluid extravasation rates calculated. Analysis of variance for repeated measurements with post-tests were used to evaluate the results with respect to differences within or between the groups.

Results

In the C-group hematocrit, net fluid balance, plasma volume and the fluid extravasation rate remained essentially unchanged throughout the study as opposed to the increase in hematocrit (P < 0.001), fluid extravasation rate (P < 0.05) and decrease in plasma volume (P < 0.001) of the P-group. Hemodynamic parameters remained stable or were slightly elevated in the C-group while the P-group demonstrated an increase in femoral venous pressure (P < 0.001), right atrial pressure (P < 0.001), pulmonary capillary wedge pressure (P < 0.01) and mean pulmonary arterial pressure (P < 0.001). The protein mass decreased in both study groups but was significantly lower in the P-group as compared with the C-group, after 240 min of intervention. The increased intra-abdominal pressure was associated with elevated intracranial pressure and reduced tissue perfusion of the pancreas and the gastric- and intestinal mucosa.

Conclusion

Elevation of intra-abdominal pressure has an immediate impact on microvascular fluid extravasation leading to plasma volume contraction, reduced cardiac output and deranged perfusion of abdominal organs.

【 授权许可】

   
2014 Elvevoll et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Santa-Teresa P, Munoz J, Montero I, Zurita M, Tomey M, Alvarez-Sala L, Garcia P: Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study. Annals Intensive Care 2012, 2(1):S3. BioMed Central Full Text
• [2]Kim IB, Prowle J, Baldwin I, Bellomo R: Incidence, risk factors and outcome associations of intra-abdominal hypertension in critically ill patients. Anaesth Intensive Care 2012, 40(1):79-89.
• [3]Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre PF, Gattinoni L: Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004, 30(5):822-829.
• [4]Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N: Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med 2008, 34(4):707-713.
• [5]Vidal MG, Ruiz Weisser J, Gonzalez F, Toro MA, Loudet C, Balasini C, Canales H, Reina R, Estenssoro E: Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med 2008, 36(6):1823-1831.
• [6]Holodinsky JK, Roberts DJ, Ball CG, Reintam Blaser A, Starkopf J, Zygun DA, Stelfox HT, Malbrain ML, Jaeschke RC, Kirkpatrick AW: Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Critical Care 2013, 17(5):R249. BioMed Central Full Text
• [7]Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, Duchesne J, Bjorck M, Leppaniemi A, Ejike JC, Sugrue M, Cheatham M, Ivatury R, Ball CG, Reintam Blaser A, Regli A, Balogh ZJ, D’Amours S, Debergh D, Kaplan M, Kimball E, Olvera C, Pediatric Guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome: Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013, 39(7):1190-1206.
• [8]Strang SG, Van Lieshout EM, Breederveld RS, Van Waes OJ: A systematic review on intra-abdominal pressure in severely burned patients. Burns 2014, 40(1):9-16.
• [9]Starling EH: On the absorption of fluids from the connective tissue spaces. J Physiol 1896, 19(4):312-326.
• [10]Regli A, De Keulenaer BL, Hockings LE, Musk GC, Roberts B, van Heerden PV: The role of femoral venous pressure and femoral venous oxygen saturation in the setting of intra-abdominal hypertension: a pig model. Shock (Augusta, Ga) 2011, 35(4):422-427.
• [11]Husby P, Heltne JK, Koller ME, Birkeland S, Westby J, Fosse R, Lund T: Midazolam-fentanyl-isoflurane anaesthesia is suitable for haemodynamic and fluid balance studies in pigs. Lab Anim 1998, 32(3):316-323.
• [12]Heltne JK, Farstad M, Lund T, Koller ME, Matre K, Rynning SE, Husby P: Determination of plasma volume in anaesthetized piglets using the carbon monoxide (CO) method. Lab Anim 2002, 36(3):344-350.
• [13]Tisdall MM, Smith M: Cerebral microdialysis: research technique or clinical tool. Br J Anaesth 2006, 97(1):18-25.
• [14]Kowallik P, Schulz R, Guth BD, Schade A, Paffhausen W, Gross R, Heusch G: Measurement of regional myocardial blood flow with multiple colored microspheres. Circulation 1991, 83(3):974-982.
• [15]Cordemans C, De Laet I, Van Regenmortel N, Schoonheydt K, Dits H, Huber W, Malbrain ML: Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Annals Intensive Care 2012, 2(1):S1. BioMed Central Full Text
• [16]Johnson PC: Autoregulation of blood flow. Circ Res 1986, 59(5):483-495.
• [17]Moore-Olufemi SD, Xue H, Allen SJ, Moore FA, Stewart RH, Laine GA, Cox CS Jr: Effects of primary and secondary intra-abdominal hypertension on mesenteric lymph flow: implications for the abdominal compartment syndrome. Shock (Augusta, Ga) 2005, 23(6):571-575.
• [18]Gudmundsson FF, Gislason HG, Dicko A, Horn A, Viste A, Grong K, Svanes K: Effects of prolonged increased intra-abdominal pressure on gastrointestinal blood flow in pigs. Surg Endosc 2001, 15(8):854-860.
• [19]Diebel LN, Dulchavsky SA, Brown WJ: Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma 1997, 43(5):852-855.
• [20]Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ: Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol 1985, 248(2 Pt 2):R208-R213.
• [21]Citerio G, Vascotto E, Villa F, Celotti S, Pesenti A: Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med 2001, 29(7):1466-1471.
• [22]Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ: A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med 1997, 25(3):496-503.
• [23]Demling RH: The burn edema process: current concepts. J Burn Care Rehabil 2005, 26(3):207-227.
• [24]Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP: Elevated intra-abdominal pressure and renal function. Ann Surg 1982, 196(5):594-597.
• [25]Olofsson PH, Berg S, Ahn HC, Brudin LH, Vikstrom T, Johansson KJ: Gastrointestinal microcirculation and cardiopulmonary function during experimentally increased intra-abdominal pressure. Crit Care Med 2009, 37(1):230-239.
• [26]Schachtrupp A, Wauters J, Wilmer A: What is the best animal model for ACS? Acta Clin Belg Suppl 2007, 1:225-232.
• [27]Bergstrom M, Falk P, Park PO, Holmdahl L: Peritoneal and systemic pH during pneumoperitoneum with CO2 and helium in a pig model. Surg Endosc 2008, 22(2):359-364.
• [28]Cheng Y, Lu J, Xiong X, Wu S, Lin Y, Wu T, Cheng N: Gases for establishing pneumoperitoneum during laparoscopic abdominal surgery. Cochrane Database Syst Rev 2013., 1CD009569
• [29]De Keulenaer BL, Regli A, Dabrowski W, Kaloiani V, Bodnar Z, Cea JI, Litvin AA, Davis WA, Palermo AM, De Waele JJ, Malbrain ML: Does femoral venous pressure measurement correlate well with intrabladder pressure measurement? A multicenter observational trial. Intensive Care Med 2011, 37(10):1620-1627.