The pathophysiological impact of intra-abdominal hypertension in pigs.

BACKGROUND

Intra-abdominal hypertension and abdominal compartment syndrome are common with clinically significant consequences. We investigated the pathophysiological effects of raised IAP as part of a more extensive exploratory animal study. The study design included both pneumoperitoneum and mechanical intestinal obstruction models.

METHODS

Forty-nine female swine were divided into six groups: a control group (Cr; n = 5), three pneumoperitoneum groups with IAPs of 20mmHg (Pn20; n = 10), 30mmHg (Pn30; n = 10), 40mmHg (Pn40; n = 10), and two mechanical intestinal occlusion groups with IAPs of 20mmHg (MIO20; n = 9) and 30mmHg (MIO30; n = 5).

RESULTS

There were significant changes (p<0.05) noted in all organ systems, most notably systolic blood pressure (SBP) (p<0.001), cardiac index (CI) (p = 0.003), stroke volume index (SVI) (p<0.001), mean pulmonary airway pressure (MPP) (p<0.001), compliance (p<0.001), pO2 (p = 0.003), bicarbonate (p = 0.041), hemoglobin (p = 0.012), lipase (p = 0.041), total bilirubin (p = 0.041), gastric pH (p<0.001), calculated glomerular filtration rate (GFR) (p<0.001), and urine output (p<0.001). SVV increased progressively as the IAP increased with no obvious changes in intravascular volume status. There were no significant differences between the models regarding their impact on cardiovascular, respiratory, renal and gastrointestinal systems. However, significant differences were noted between the two models at 30mmHg, with MIO30 showing worse metabolic and hematological parameters, and Pn30 and Pn40 showing a more rapid rise in creatinine.

CONCLUSIONS

This study identified and quantified the impact of intra-abdominal hypertension at different pressures on several organ systems and highlighted the significance of even short-lived elevations. Two models of intra-abdominal pressure were used, with a mechanical obstruction model showing more rapid changes in metabolic and haematological changes. These may represent different underlying cellular and vascular pathophysiological processes, but this remains unclear.

Informations de copyright

Copyright: © 2023 Wise et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Déclaration de conflit d'intérêts

Robert Wise: Dr. Wise declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. He is currently a member of the WSACS. Reitze Rodseth: Prof. Rodseth declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. He is supported in part by the National Research Foundation of South Africa. Ester Párraga-Ros: Prof. Párraga-Ros declares that she has no financial or personal relationships that may have inappropriately influenced him in writing this paper. Rafael Latorre: Prof. Latorre declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. Octavio López Albors: Prof. Lopez Albors declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. Laura Correa-Martín: Prof. Correa-Martín declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. Francisco M. Sánchez-Margallo: Prof. Sánchez-Margallo declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. Irma Eugenia Candanosa-Aranda: Prof. Candanosa-Aranda declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. Jan Poelaert: Prof. Poelaert declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. Gregorio Castellanos: Prof. Castellanos declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this paper. Manu L. N. G. Malbrain: MLNGM is Professor of Critical Care Research at the 1st Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland. He is co-founder, past-President and current Treasurer of WSACS (The Abdominal Compartment Society, http://www.wsacs.org). He is member of the medical advisory Board of Pulsion Medical Systems (part of Getinge group, Solna, Sweden), Serenno Medical, Potrero Medical, Sentinel Medical Technologies and Baxter. He consults for BBraun, Becton Dickinson, ConvaTec, Spiegelberg, and Holtech Medical, and received speaker’s fees from PeerVoice. He holds stock options for Serenno and Potrero. He is co-founder and President of the International Fluid Academy (IFA). The IFA (http://www.fluidacademy.org) is integrated within the not-for-profit charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law.