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      Time-course evaluation of intestinal structural disorders in a porcine model of intra-abdominal hypertension by mechanical intestinal obstruction

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          Abstract

          Background

          A mechanical intestinal obstruction (MIO) can generate intraabdominal hypertension (IAH) that is life threatening. The intestines are very sensitive to IAH since the low splanchnic perfusion causes intestinal hypoxia, local acidosis and bacterial translocations. This may lead to acute intestinal distress syndrome (AIDS). The identification of intestinal injuries during IAH and its correlation with clinical parameters as the abdominal perfusion pressure (APP), the gastric intramucosal pH (pHi) and lactic acid (Lc) are still unknown. This study aimed to evaluate the sequence of intestinal histopathological findings in an MIO model and to analyze potential relationships with parameters currently used in clinical practice (APP, pHi and Lc).

          Material and methods

          Twenty pigs were divided into three groups: a control group (n = 5) and two experimental groups with 20 mmHg (G1, n = 10) and 30 mmHg (G2, n = 5) of IAH by MIO. The pressures were maintained for 3 hours, except in 5 animals in G1 where it was maintained for 5 hours. The APP, pHi and LA were recorded and biopsies of the terminal ileum were taken every 30 minutes in all groups. The intestinal damage was graded according to the Park Score.

          Results

          Intestinal injuries were found in 42.9% of pigs in the experimental groups. The lesions were independent of the level and duration of IAH. Although APP and pHi were slightly lower in injured animals (I +) of G1 and G2, there were no significant differences among those uninjured (I-). Lc was significantly increased in all I+ pigs from the onset of IAH.

          Conclusion

          The IAH by MIO causes intestinal lesions from the first 30 minutes with concurrent decreases in APP and pHi and increases in Lc. Lc could be the best clinical parameter related to intestinal damages with a clear difference between I + and I- animals.

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          Most cited references42

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          Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal.

          The diagnosis of intra-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS) is heavily dependent on the reproducibility of the intra-abdominal pressure (IAP) measurement technique. Recent studies have shown that a clinical estimation of IAP by abdominal girth or by examiner's feel of the tenseness of the abdomen is far from accurate, with a sensitivity of around 40%. Consequently, the IAP needs to be measured with a more accurate, reproducible and reliable tool. The role of the intra-vesical pressure (IVP) as the gold standard for IAP has become a matter of debate. This review will focus on the previously described indirect IAP measurement techniques and will suggest new revised methods of IVP measurement less prone to error. Cost-effective manometry screening techniques will be discussed, as well as some options for the future with microchip transducers.
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            Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension.

            To assess the clinical utility of abdominal perfusion pressure (mean arterial pressure minus intra-abdominal pressure) as both a resuscitative endpoint and predictor of survival in patients with intra-abdominal hypertension. 144 surgical patients treated for intra-abdominal hypertension between May 1997 and June 1999 were retrospectively reviewed. Multivariate logistic regression and receiver operating characteristic curve analysis of common physiologic variables and resuscitation endpoints were performed to determine the decision thresholds for each variable that predict patient survival. Abdominal perfusion pressure was statistically superior to both mean arterial pressure and intravesicular pressure in predicting patient survival from intra-abdominal hypertension and abdominal compartment syndrome. Multiple regression analysis demonstrated that abdominal perfusion pressure was also superior to other common resuscitation endpoints, including arterial pH, base deficit, arterial lactate, and hourly urinary output. Abdominal perfusion pressure appears to be a clinically useful resuscitation endpoint and predictor of patient survival during treatment for intra-abdominal hypertension and abdominal compartment syndrome.
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              Intestinal ischemia/reperfusion: microcirculatory pathology and functional consequences.

              Intestinal ischemia and reperfusion (I/R) is a challenging and life-threatening clinical problem with diverse causes. The delay in diagnosis and treatment contributes to the continued high in-hospital mortality rate. Experimental research during the last decades could demonstrate that microcirculatory dysfunctions are determinants for the manifestation and propagation of intestinal I/R injury. Key features are nutritive perfusion failure, inflammatory cell response, mediator surge and breakdown of the epithelial barrier function with bacterial translocation, and development of a systemic inflammatory response. This review provides novel insight into the basic mechanisms of damaged intestinal microcirculation and covers therapeutic targets to attenuate intestinal I/R injury. The opportunity now exists to apply this insight into the translation of experimental data to clinical trial-based research. Understanding the basic events triggered by intestinal I/R may offer new diagnostic and therapeutic options in order to achieve improved outcome of patients with intestinal I/R injury.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                22 January 2018
                2018
                : 13
                : 1
                : e0191420
                Affiliations
                [1 ] Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
                [2 ] Laparoscopy Department, Jesús Usón Minimally Invasive Surgery Centre (JUMISC), Cáceres, Spain
                [3 ] Highlands Teaching and Research Farm (CEIEPAA), Faculty of Veterinary Medicine, National Autonomous University of México, Querétaro, México
                [4 ] Medical and Surgical ICU and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg/St-Erasmus, Antwerp, Belgium
                [5 ] Critical Care Unit, Edendale Hospital, Pietermaritzburg, South Africa
                [6 ] Discipline of Anaesthesiology and Critical Care Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
                [7 ] Department of General Surgery, Virgen de la Arrixaca General University Hospital, Murcia, Spain
                INIA, SPAIN
                Author notes

                Competing Interests: MLNG Malbrain is a member of the medical advisory board of Pulsion Medical Systems, but this does not alter our adherence to PlosOne policies on sharing data and materials.

                ‡ These authors also contributed equally to this work.

                Author information
                http://orcid.org/0000-0001-7704-2549
                Article
                PONE-D-17-32958
                10.1371/journal.pone.0191420
                5777654
                29357386
                ae1d247c-5943-475c-bb5d-c77aa492e532
                © 2018 Párraga Ros 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.

                History
                : 9 September 2017
                : 4 January 2018
                Page count
                Figures: 12, Tables: 1, Pages: 17
                Funding
                Funded by: Extremadura Regional Government. Spain
                Award ID: PRI09A161
                Award Recipient :
                Funded by: Extremadura Regional Government. Spain
                Award ID: PRI09A161
                Award Recipient :
                This work was supported by one grant from Extremadura Regional Government through the Plan Regional de Investigación de Extremadura, Spain (PRI09A161 to Minimally Invasive Surgery Center Jesús Usón) to FSM and GCE. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Biology and Life Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Medicine and Health Sciences
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                Digestive System
                Gastrointestinal Tract
                Research and Analysis Methods
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