Temporal differences in the development of organ dysfunction based on two different approaches to induce experimental intra-abdominal hypertension in swine

摘要

Background Intra-abdominal hypertension [IAH] occurs frequently among critically ill patients and is associated with increased mortality and organ failure. Two porcine models of IAH that cause abdominal compartment syndrome [ACS] with organ dysfunction were created. We investigated whether the two methods used to create IAH - CO₂ pneumoperitoneum or adding volume to the intra-abdominal space - exerted different impacts on the temporal development of organ dysfunction. Methods Twenty-four 40-kg female pigs were allocated to four groups: 25 mmHg IAH with CO₂ pneumoperitoneum ( n = 8), > 20 mmHg IAH caused by addition of volume ( n = 8), and two corresponding sham groups (each n = 4). The two sham groups were later pooled into one control group ( n = 8). The animals were monitored for 12 h. Repeated serial measurements were taken of group differences over time and analyzed using analysis of variance. Results Thirty-eight percent of the animals ( n = 3) in each intervention group died near the end of the 12-h experiment. Both intervention groups experienced kidney impairment: increased creatinine concentration ( P 0.0001), anuria ( P = 0.0005), hyperkalemia ( P 0.0001), decreased abdominal perfusion pressure, and decreased dynamic lung compliance. CO₂ pneumoperitoneum animals developed hypercapnia ( P 0.0001) and acidosis ( P 0.0001). Conclusions Both methods caused ACS and organ dysfunction within 12 h. Hypercapnia and acidosis developed in the CO₂ pneumoperitoneum group.