Dia 1

1
Fluid-resuscitated fecal peritonitis in pigs as a
model of intra-abdominal hypertension (IAH)
J. Wauters1, A. Dieudonne1, S. Thiessen1, K.Van
Zwam1, M. Malbrain2, A. Wilmer1 1 Intensive Care
Medicine, University Hospital Gasthuisberg,
Leuven, Belgium 2 Intensive Care Unit,
Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg,
Antwerpen, Belgium
World Congres ACS Antwerp, March 21-24th 2007
2
Introduction fluids and IAP
No data on IAP

• Relation between fluid balance/type of fluid and
  IAP
• Balogh, Arch Surg 2003
• Malbrain, CCM 2005
• OMara, J Trauma 2005

3
Introduction fluids and IAP
N33, p lt 0.001
OMara, J Trauma 2005
0.56l/kg
0.36l/kg
4
Introduction

• Relation between fluid balance/type of fluid and
  IAP
• ACS is not so frequent (1-15)
• gt prospective multicentre intervention trials
  will take some time

gt Need for large animal models
5
Introduction animal models

• Pathological animal models that produce
  IAH/ACS as second hit
• Trauma/hemorrhage resuscitation
• SIRS sepsis, burns, resuscitation
• IAP elevation due to capillary leak aggressive
  fluid resuscitation (crystalloids)
• More invasive measurement possibilities to
  understand pathophysiology
• Regional/local hemodynamics
• (in vivo) biopsies,
• Evaluation of interventions

6
Material and methods24h porcine fecal
peritonitis model

• Aim proof of concept fluid-resuscitated 24h
  porcine fecal peritonitis can produce elevated
  IAP
• Setup
• 6 anesthetized pigs (403kg), 15
  anti-Trendelenburg
• Portal vein (PV) and hepatic artery (AH) flow
  flow probes
• IAP direct Spiegelberg (near PV)
• Statistics
• Differences within groups repeated measures
  ANOVA with Bonferroni test
• Differences between groups unpaired t-test with
  Bonferroni-Holm correction

7
Results
a plt0.05 within groups, b plt0.05 between groups
8
Results
9
Conclusions

• There is a need for large animal models that
  produce elevated IAP
• A pathological 24h-porcine fecal peritonitis
  model can produce IAH due to fluid-resuscitation
  
• IAP elevation correlates with fluid balance
• Resuscitation-induced tissue edema (ascites)
  probably accounts for IAH
• Future work
• more elevated IAP from IAH to ACS
• Organ function and histological tissue analysis
• Intervention less fluid? more vasopression?
  Decompression?

10
Thank you !!!
Dr. J. Wauters1, Dr. P. Claus2, A. Dieudonne1, K.
Van Zwam1, S. Thiessen1, Dr. M. Malbrain3, Prof.
Dr. A. Wilmer1
1Medical Intensive Care Unit, 2Cardiac Imaging UZ
Gasthuisberg, Leuven, Belgium, 3Stuivenbergziekenh
uis, Antwerp, Belgium