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Carbon dioxide pneumoperitoneum prevents mortality from sepsis

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Abstract

Background

Carbon dioxide (CO2) pneumoperitoneum has been shown to attenuate the inflammatory response after laparoscopy. This study tested the hypothesis that abdominal insufflation with CO2 improves survival in an animal model of sepsis and investigated the associated mechanism.

Methods

The effect of CO2, helium, and air pneumoperitoneum on mortality was studied by inducing sepsis in 143 rats via intravenous injection of lipopolysaccharide (LPS). To test the protective effect of CO2 in the setting of a laparotomy, an additional 65 animals were subjected to CO2 pneumoperitoneum, helium pneumoperitoneum, or the control condition after laparotomy and intraperitoneal LPS injection. The mechanism of CO2 protection was investigated in another 84 animals. Statistical significance was determined via Kaplan– Meier analysis for survival and analysis of variance (ANOVA) for serum cytokines.

Results

Among rats with LPS-induced sepsis, CO2 pneumoperitoneum increased survival to 78%, as compared with using helium pneumoperitoneum (52%; p < 0.05), air pneumoperitoneum (55%; p = 0.09), anesthesia control (50%; p < 0.05), and LPS-only control (42%; p < 0.01). Carbon dioxide insufflation also significantly increased survival over the control condition (85% vs 25%; p < 0.05) among laparotomized septic animals, whereas helium insufflation did not (65% survival). Carbon dioxide insufflation increased plasma interleukin-10 (IL-10) levels by 35% compared with helium pneumoperitoneum (p < 0.05), and by 34% compared with anesthesia control (p < 0.05) 90 min after LPS stimulation. Carbon dioxide pneumoperitoneum resulted in a threefold reduction in tumor necrosis factor-α (TNF-α) compared with helium pneumoperitoneum (p < 0.05), and a sixfold reduction with anesthesia control (p < 0.001).

Conclusion

Abdominal insufflation with CO2, but not helium or air, significantly reduces mortality among animals with LPS-induced sepsis. Furthermore, CO2 pneumoperitoneum rescues animals from abdominal sepsis after a laparotomy. Because IL-10 is known to downregulate TNF-α, the increase in IL-10 and the decrease in TNF-α found among the CO2-insufflated animals in our study provide evidence for a mechanism whereby CO2 pneumoperitoneum reduces mortality via IL-10-mediated downregulation of TNF-α.

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Acknowledgments

The authors thank Tiffany Edwards for her assistance with animal care in the study experiments. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense.

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Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 665, Baltimore, MD, 21287-4665, USA

    E. J. Hanly, J. M. Fuentes, A. R. Aurora, S. L. Bachman, A. De Maio, M. R. Marohn & M. A. Talamini

  2. Department of Surgery, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    E. J. Hanly

  3. Department of Surgery, Malcolm Grow Medical Center, 1050 West Perimeter Road, Andrews AFB, MD, 20762, USA

    E. J. Hanly

Authors
  1. E. J. Hanly
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  2. J. M. Fuentes
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  3. A. R. Aurora
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  4. S. L. Bachman
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  5. A. De Maio
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  6. M. R. Marohn
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  7. M. A. Talamini
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Corresponding author

Correspondence to M. A. Talamini.

Additional information

Supported by R01-GM062899-02, National Institutes of Health, Bethesda, MD. Presented at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Ft. Lauderdale, Florida, 13–16 April 2005

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Hanly, E.J., Fuentes, J.M., Aurora, A.R. et al. Carbon dioxide pneumoperitoneum prevents mortality from sepsis. Surg Endosc 20, 1482–1487 (2006). https://doi.org/10.1007/s00464-005-0246-y

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  • DOI: https://doi.org/10.1007/s00464-005-0246-y

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