J Surg Res. 2013 Oct;184(2):1028-34.

Tonometry as a predictor of inadequate splanchnic perfusion in an intra-abdominal hypertension animal model.

Laura Correa-Martína, Gregorio Castellanosb, Mónica García-Lindoc, Idoia Díaz-Güemesa and Francisco M. Sánchez-Margalloa

 

a Department of Laparoscopy, Jesús Usón Minimally Invasive Surgery Center (JUMISC), Cáceres, Spain

b Department of General Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain

c Department of Anesthesiology, Jesús Usón Minimally Invasive Surgery Center (JUMISC), Cáceres, Spain

 

Abstract

Background. The gastrointestinal system is the most sensitive to the presence of intraabdominal hypertension (IAH). We aimed to assess the early prognostic value of gastric air tonometry as a predictor of inadequate splanchnic perfusion and determine its relation with abdominal perfusion pressure (APP).

Methods. 25 Large White swine were used for this study. A control group and two study groups were included, in which intraabdominal pressure (IAP) was elevated with C02 to 20 mmHg and 30 mmHg during 5 hours. We measured the intramucosal gastric pH (pHim), and determined gastric luminal PCO2 (PgCO2) and PgCO2gap (gastric luminal CO2 – arterial CO2) to evaluate gastric acidity. APP was indirectly obtained through IAP and mean arterial pressure. Additionally, histopathologic samples of small intestine were obtained and analyzed.

Results. pHim showed a decrease in IAP groups, with statistical significance in the 30 mmHg group, 90 min after stabilization period (p<0,01). Serum lactate showed delayed alteration when compared to pHim, with significant increase 180 min after stabilization (p<0,05). The values of PgCO2and PCO2 gap were increased in IAP groups, being statistically significant in the 30 mmHg group, 120 min and 150 min respectively after stabilization. In increased IAP groups there was a time progressive decrease of APP, with statistically significant differences observed between groups at 20 min (p<0,001). The histopathology study revealed parenchymal injury of the intestine at 30 mmHg.

Conclusions: Tonometry is sensitive to the increase in IAP, and relates to the reduction of APP generated by splanchnic hypoperfusion.

PMID: 23688792

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