Abstract
Objective
To investigate whether microdialysis is capable of assessing metabolic derangements during intra-abdominal hypertension (IAH), and whether monitoring of the rectus abdominis muscle (RAM) by microdialysis represents a reliable approach in the early detection of organ dysfunctions in abdominal compartment syndrome (ACS).
Design
Prospective, randomized, controlled animal study.
Setting
University animal research facility.
Subjects
Fifteen isoflurane-anesthetized and mechanically ventilated Sprague–Dawley rats.
Interventions
IAH of 20 mmHg was induced for 3 h and followed by decompression and reperfusion for another 3-h period (n = 10). Five sham-operated animals served as controls. Microdialysis was performed in the anterior gastric wall, liver, kidney, and RAM. The anterior cervical muscles served as distant reference. Glucose, lactate, pyruvate, and glycerol was analyzed throughout the 6-h experiment.
Measurements and main results
Prolonged IAH induced significant cardiopulmonary dysfunction and persistent abdominal organ injury. Microdialysis revealed a significant increase of lactate/pyruvate and glycerol in kidney, intestine and liver, indicating ischemia, energy failure, and cell membrane damage. In addition, at 3 h IAH glucose was significantly decreased in all organs studied. The distant reference did not show any alteration of lactate/pyruvate, glycerol, and glucose over the entire 6-h observation period. In contrast to the other organs, microdialysis of the RAM showed an early and more pronounced increase of lactate, lactate/pyruvate and glycerol already at 1 h IAH. It is noteworthy that lactate, glycerol, and glucose did not completely recover upon decompression of IAH.
Conclusions
Our data suggest that continuous microdialysis in the RAM may represent a promising tool for early detecting IAH-induced metabolic derangements.
Similar content being viewed by others
References
Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2006) Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 32:1722–1732
Rezende-Neto JB, Moore EE, Melo de Andrade MV, Teixeira MM, Lisboa FA, Arantes RM, de Souza DG, da Cunha-Melo Jr (2002) Systemic inflammatory response secondary to abdominal compartment syndrome: setting the stage for multiple organ failure. J Trauma 53:1121–1128
Rezende-Neto JB, Moore EE, Masuno T, Moore PK, Johnson JL, Sheppard FR, Cunha-Melo JR, Silliman CC (2003) The abdominal compartment syndrome as a second insult during systemic neutrophil priming provokes multiple organ injury. Shock 20:303–308
Oda J, Ivatury RR, Blocher CR, Malhotra AJ, Sugarman HJ (2002) Amplified cytokine response and lung injury by sequential hemorrhagic shock and abdominal compartment syndrome in a laboratory model of ischaemia–reperfusion. J Trauma 52:625–632
Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L (2005) Incidence and prognosis of Intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 33:315–322
Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, Japiassu A, Kurtop E, De Keulenaer BL, Daelemans R, Del Turco M, Cosimini P, Ranieri M, Jacquet L, Laterre PF, Gattinoni L (2004) Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 30:822–829
Kimball EJ, Rollins MD, Mone MC, Hansen HJ, Baraghoshi GK, Johnston C, Day ES, Jackson PR, Payne M, Barton RG (2006) Survey of ICU physicians on the recognition and management of intra-abdominal hypertension and abdominal compartment syndrome. Crit Care Med 34:2340–2348
Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozar RA, Valdivia A, Ware DN, Moore FA (2003) Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 54:848–861
Sugrue M, Jones F, Janjua KJ, Deane SA, Bristow P, Hillman K (1998) Temporary abdominal closure: a prospective evaluation of its effects on renal and respiratory physiology. J Trauma 45:914–921
Engstrom M, Polito A, Reinstrup P, Romner B, Ryding E, Ungerstedt U, Nordstrom CH (2005) Intracerebral microdialysis in severe brain trauma: the importance of catheter location. J Neurosurg 102:460–469
Nowak G, Ungerstedt J, Wernerson A, Ungerstedt U, Ericzon BG (2003) Hepatic cell membrane damage during cold preservation sensitizes liver grafts to rewarming injury. J Hepatobiliary Pancreat Surg 10:200–205
Roidmark J, Heden P, Ungerstedt U (2000) Prediction of border necrosis in skin flaps of pigs with microdialysis. J Reconstr Microsurg 16:129–134
Langemann H, Habicht J, Mendelowitsch A, Kanner A, Alessandri B, Landolt H, Gratzl O (1996) Microdialytic monitoring during a cardiovascular operation. Acta Neurochir (Suppl) 67:70–74
Nowak G, Ungerstedt J, Wernerman J, Ungerstedt U, Ericzon BG (2002) Clinical experience in continuous graft monitoring with microdialysis early after liver transplantation. Br J Surg 89:1169–1175
Nowak G, Ungerstedt J, Wernerman J, Ungerstedt U, Ericzon BG (2002) Metabolic changes in the liver graft monitored continuously with microdialysis during liver transplantation in a pig model. Liver Transplant 8:424–432
Hillered L, Persson L (1999) Neurochemical monitoring of the acutely injured human brain. Scand J Clin Lab Invest (Suppl l) 229:9–18
Nilsson OG, Brandt L, Ungerstedt U, Saveland H (1999) Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45:1176–1184
Ungerstedt J, Nowak G, Ericzon BG, Ungerstedt U (2003) Intraperitoneal microdialysis (IPM): a new technique for monitoring intestinal ischemia studied in a porcine model. Shock 20:91–96
Klaus S, Heringlake M, Gliemroth J, Bruch HP, Bahlmann L (2002) Intraperitoneal microdialysis for detection of splanchnic metabolic disorders. Langenbecks Arch Surg 387:276–280
Solligard E, Juel IS, Bakkelund K, Jynge P, Tvedt KE, Johnson H, Aadahl P, Gronbech JE (2005) Gut luminal microdialysis of glycerol as a marker of intestinal ischemic injury and recovery. Crit Care Med 33:2278–2285
Meier C, Schramm R, Holstein JH, Seifert B, Trentz O, Menger MD (2006) Measurement of compartment pressure of the rectus sheath during intra-abdominal hypertension in rats. Intensive Care Med 32:1644–1648
Meier C, Contaldo C, Schramm R, Holstein JH, Hamacher J, Amon M, Wanner G, Trentz O, Menger MD (2007) A new model for the study of the abdominal compartment syndrome in rats. J Surg Res (Epub ahead of print)
Ungerstedt U (1991) Microdialysis: principles and applications for studies in animals and man. J Intern Med 230:365–373
Hamrin K, Rosdahl H, Ungerstedt U, Henriksson J (2002) Microdialysis in human skeletal muscle: effects of adding a colloid to the perfusate. J Appl Physiol 92:385–393
Trickler WJ, Miller DW (2003) Use of osmotic agants in microdialysis studies to improve the recovery of macromolecules. J Pharm Sci 92:1419–1427
Toens C, Schachtrupp A, Hoer J, Junge K, Klosterhalfen B, Schumpelick V (2002) A porcine model of the abdominal compartment syndrome. Shock 18:316–321
Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ (1995) Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma 39:1071–1075
Cullen DJ, Coyle JP, Teplick R, Long MC (1989) Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med 17:118–121
Raeburn CD, Moore EE, Biffl LW, Johnson JL, Meldrum DR, Offner PJ, Franciose RJ, Burch JM (2001) The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg 182:542–546
Eleftheriadis E, Kotzampassi K, Papanotas K, Heliadis N, Sarris K (1996) Gut ischemia, oxidative stress, and bacterial translocation in elevated abdominal pressure in rats. World J Surg 20:11–16
Diebel LN, Dulchavsky SA, Brown WJ (1997) Splanchnic ischaemia and bacterial translocation in the abdominal compartment syndrome. J Trauma 43:852–855
Diebel LN, Wilson RF, Dulchavsky SA, Wilson RF (1992) Effect of increased intra-abdominal pressure on hepatic arterial portal venous, and hepatic microcirculatory blood flow. J Trauma 33:279–282
Richter S, Olinger A, Hildebrandt U, Menger MD, Vollmar B (2001) Loss of physiologic hepatic blood flow control (“hepatic arterial buffer response”) during CO2-pneumoperitoneum in the rat. Anesth Analg 93:872–877
Varela JE, Cohn SM, Giannotti GD, Dolich MO, Ramon H, Wiseberg JA, McKenney M (2001) Near-infrared spectroscopy reflects changes in mesenteric and systemic perfusion during abdominal compartment syndrome. Surgery 129:363–370
Ivatury RR, Porter JM, Simon RJ, Islam S, John R, Stahl WM (1998) Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 44:1016–1023
Sugrue M, Jones F, Lee A, Buist M, Deane S, Bauman A, Hillman K (1996) Intra-abdominal pressure and gastric intramucosal pH: Is there an association? World J Surg 20:988–991
Krejci V, Hiltebrand L, Buechi C, Ali SZ, Contaldo C, Takala J, Sigurdsson G, Jakob SM (2006) Decreasing gut wall glucose as an early marker of impaired intestinal perfusion. Crit Care Med 34:2406–2414
Menger MD, Steiner D, Messmer K (1992) Microvascular ischemia-reperfusion injury in striated muscle: significance of “no reflow”. Am J Physiol 263:H1892–H1900
Menger MD, Rücker M, Vollmar B (1997) Capillary dysfunction in striated muscle ischemia/reperfusion: on the mechanisms of capillary “no-reflow”. Shock 8:2–7
Diebel L, Saxe J, Dulchavsky S (1992) Effect of intra-abdominal pressure on abdominal wall blood flow. Am Surg 58:573–575
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-007-0724-x.
Electronic supplementary material
Rights and permissions
About this article
Cite this article
Meier, C., Contaldo, C., Schramm, R. et al. Microdialysis of the rectus abdominis muscle for early detection of impending abdominal compartment syndrome. Intensive Care Med 33, 1434–1443 (2007). https://doi.org/10.1007/s00134-007-0725-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-007-0725-9