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Microdialysis of the rectus abdominis muscle for early detection of impending abdominal compartment syndrome

Meier, Christoph ; Contaldo, Claudio ; Schramm, Rene ; Holstein, Joerg ; Hamacher, Juerg ; Amon, Michaela ; Wanner, Guido ; Trentz, Otmar ; Menger, Michael

In: Intensive Care Medicine, 2007, vol. 33, no. 8, p. 1434-1443

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    Titre
    • Microdialysis of the rectus abdominis muscle for early detection of impending abdominal compartment syndrome
    Auteur
    • Meier, Christoph. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
    • Contaldo, Claudio. Division for Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Schramm, Rene. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
    • Holstein, Joerg. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
    • Hamacher, Juerg. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
    • Amon, Michaela. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
    • Wanner, Guido. Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Trentz, Otmar. Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Menger, Michael. Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:313663
    Summary
    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 areliable 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 asignificant 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 apromising tool for early detecting IAH-induced metabolic derangements