Hipertensión intraabdominal: consecuencias sobre la circulación esplácnica. Estudio preliminar en un modelo de ascitis

Correa-Martín, Laura; Castellanos, Gregorio; Garcia-Lindo, Monica; Dı́az-Güemes, Idoia; Piñero, Antonio; Sánchez‐Margallo, Francisco M.

doi:10.1016/j.gastrohep.2013.08.002

Cited by 5 publications

(11 citation statements)

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“…In our results P a CO 2 increased by around 25% which is in keeping with the results found by Diaz et al [ 41 ] and similar to other work using a porcine model of pneumoperitoneum up to 30 mmHg [ 45 , 47 ]. In previous IAH models using 20 mmHg and 30 mmHg [ 43 , 44 , 46 , 48 , 49 ], lactate increases were noted but only became apparent and significant after 3 to 6 hours. Lactate levels in our MIO model increased by up to 5 times compared to the control group before 3 hours.…”

Section: Discussionmentioning

confidence: 91%

“…These results were consistent with previous studies simulating IAH via fluid instillation into the abdominal cavity [ 41 , 42 ] or a pneumoperitoneum model [ 43 – 47 ], and showing a decrease in CI and increase in SVRI compared to the baseline. With regard to the MAP, although an initial increase has been described [ 38 , 41 ], a significant decrease is a common finding in different IAH models [ 42 – 49 ]. In contrast to previous works [ 42 – 49 ] where such a decrease was only observed after several hours of increased IAP, we noticed a drop in MAP just after stabilization of IAH.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to the MAP, although an initial increase has been described [ 38 , 41 ], a significant decrease is a common finding in different IAH models [ 42 – 49 ]. In contrast to previous works [ 42 – 49 ] where such a decrease was only observed after several hours of increased IAP, we noticed a drop in MAP just after stabilization of IAH. This may be explained by a greater effect of the MIO model on MAP compared to previously studied models.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent reviews on IAH and ACS [ 33 , 36 – 38 , 57 ] emphasize the negative impact of increased IAP on splanchnic perfusion, which can be significantly decreased in both animal [ 36 , 43 , 49 , 58 , 59 ] and humans models [ 9 – 11 , 37 , 38 ]. In relation to this, APP has been suggested as a reliable and easy parameter to assess abdominal perfusion [ 27 , 39 , 60 ] following retrospective analysis which showed it reflected the impact of increased IAP on tissue perfusion better than IAP or MAP alone.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

et al. 2016

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IntroductionMechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology.Materials and MethodsFifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min.ResultsSignificant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours.ConclusionThe mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

et al. 2016

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“…Another limitation was that one study did not mention whether their patients received gastric acid inhibition [ 16 ], so the precise value of pHi may be affected to a degree. Finally, Correa-Martin and colleagues performed two studies and demonstrated that tonometry was sensitive to the increase of intra-abdominal pressure [ 34 , 35 ], but none of the included six studies excluded patients with high intra-abdominal pressure.…”

Section: Discussionmentioning

confidence: 99%

Gastric tonometry guided therapy in critical care patients: a systematic review and meta-analysis

et al. 2015

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IntroductionThe value of gastric intramucosal pH (pHi) can be calculated from the tonometrically measured partial pressure of carbon dioxide () in the stomach and the arterial bicarbonate content. Low pHi and increase of the difference between gastric mucosal and arterial ( gap) reflect splanchnic hypoperfusion and are good indicators of poor prognosis. Some randomized controlled trials (RCTs) were performed based on the theory that normalizing the low pHi or gap could improve the outcomes of critical care patients. However, the conclusions of these RCTs were divergent. Therefore, we performed a systematic review and meta-analysis to assess the effects of this goal directed therapy on patient outcome in Intensive Care Units (ICUs).MethodsWe searched PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials comparing gastric tonometry guided therapy with control groups. Baseline characteristics of each included RCT were extracted and displayed in a table. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. Another measure of effect (risk difference, RD) was used to reassess the effects of gastric tonometry on total mortality. We performed sensitivity analysis for total mortality. Continuous outcomes were presented as standardised mean differences (SMDs) together with 95% CIs.ResultsThe gastric tonometry guided therapy significantly reduced total mortality (OR, 0.732; 95% CI, 0.536 to 0.999, P = 0.049; I2 = 0%; RD, −0.056; 95% CI, −0.109 to −0.003, P = 0.038; I2 = 0%) when compared with control groups. However, after excluding the patients with normal pHi on admission, the beneficial effects of this therapy did not exist (OR, 0.736; 95% CI 0.506 to 1.071, P = 0.109; I2 = 0%). ICU length of stay, hospital length of stay and days intubated were not significantly improved by this therapy.ConclusionsIn critical care patients, gastric tonometry guided therapy can reduce total mortality. Patients with normal pHi on admission contributed to the ultimate result of this outcome; it may indicate that these patients may be more sensitive to this therapy.

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Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension

et al. 2018

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Hipertensión intraabdominal: consecuencias sobre la circulación esplácnica. Estudio preliminar en un modelo de ascitis

Cited by 5 publications

References 22 publications

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

Gastric tonometry guided therapy in critical care patients: a systematic review and meta-analysis

Intestinal histopathological changes in a porcine model of pneumoperitoneum-induced intra-abdominal hypertension

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