Ischemia as a possible effect of increased intra-abdominal pressure on central nervous system cytokines, lactate and perfusion pressures

Abstract

IntroductionThe aims of our study were to evaluate the impact of increased intra-abdominal pressure (IAP) on central nervous system (CNS) cytokines (Interleukin 6 and tumor necrosis factor), lactate and perfusion pressures, testing the hypothesis that intra-abdominal hypertension (IAH) may possibly lead to CNS ischemia.MethodsFifteen pigs were studied. Helium pneumoperitoneum was established and IAP was increased initially at 20 mmHg and subsequently at 45 mmHg, which was finally followed by abdominal desufflation. Interleukin 6 (IL-6), tumor necrosis factor alpha (TNFa) and lactate were measured in the cerebrospinal fluid (CSF) and intracranial (ICP), intraspinal (ISP), cerebral perfusion (CPP) and spinal perfusion (SPP) pressures recorded.ResultsIncreased IAP (20 mmHg) was followed by a statistically significant increase in IL-6 (p = 0.028), lactate (p = 0.017), ICP (p < 0.001) and ISP (p = 0.001) and a significant decrease in CPP (p = 0.013) and SPP (p = 0.002). However, further increase of IAP (45 mmHg) was accompanied by an increase in mean arterial pressure due to compensatory tachycardia, followed by an increase in CPP and SPP and a decrease of cytokines and lactate.ConclusionsIAH resulted in a decrease of CPP and SPP lower than 60 mmHg and an increase of all ischemic mediators, indicating CNS ischemia; on the other hand, restoration of perfusion pressures above this threshold decreased all ischemic indicators, irrespective of the level of IAH.

Elevation of Intra-Abdominal Pressure by Pneumoperitoneum Decreases Pancreatic Perfusion in an In Vivo Porcine Model

“…Thus far, in vivo blood flow changes have been reported in the brain, spinal cord, intestinal mucosa, liver, and kidneys. [1][2][3][4][5][18][19][20][21] The effects of pneumoperitoneum on the pancreas have not been investigated due to the challenges associated with in vivo assessment.…”

Pressure, perfusion, and compartments

“…Further support for the interplay between the compartments was shown by a porcine study from Greece. 19 IAH significantly reduced cerebral and spinal perfusion pressures, concomitantly increasing interleukin 6, lactate, and tumor necrosis factor > in cerebrospinal fluid, suggesting the development of central nervous system ischemia. This effect was transient and reversible when perfusion pressures were restored to a level greater than 60 mm Hg, irrespective of the level of IAH, an alternative to abdominal decompression as a therapeutic option.…”

Effect of Increased Intra-abdominal Pressure on Liver Histology and Hemodynamics: An Experimental Study

“…Interestingly, IAH has been demonstrated to be a truly systemic condition, whose effects range from decreased cardiac output, impaired abdominal perfusion and reduced lung capacity to compromised renal function and even increased intracranial pressure (7,(12)(13)(14)(15)(16)(17). Consequently, it is not surprising that IAH has also been shown to have detrimental effects on the liver.…”