title: Carbon dioxide pneumoperitoneum prevents mortality from sepsis.
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-alpha (TNF-alpha) compared with helium pneumoperitoneum (p < 0.05), and a sixfold reduction with anesthesia control (p < 0.001).
  
  
  CONCLUSIONS
  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-alpha, the increase in IL-10 and the decrease in TNF-alpha 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-alpha.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 665, Baltimore, MD 21287-4665, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Hanly
authors.forename: J M
authors.initials: JM
authors.lastname: Fuentes
authors.forename: A R
authors.initials: AR
authors.lastname: Aurora
authors.forename: S L
authors.initials: SL
authors.lastname: Bachman
authors.forename: A
authors.initials: A
authors.lastname: De Maio
authors.forename: M R
authors.initials: MR
authors.lastname: Marohn
authors.forename: M A
authors.initials: MA
authors.lastname: Talamini
mesh_terms: D000005:Abdomen / Q000382:microbiology; D000818:Animals; D002245:Carbon Dioxide; D015536:Down-Regulation; D016753:Interleukin-10 / Q000378:metabolism; D007813:Laparotomy / Q000009:adverse effects; D008070:Lipopolysaccharides; D008297:Male; D011028:Pneumoperitoneum, Artificial; D051381:Rats; D017207:Rats, Sprague-Dawley; D016879:Salvage Therapy; D018805:Sepsis / Q000139:chemically induced / Q000209:etiology / Q000401:mortality*; D016019:Survival Analysis; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002245:Carbon Dioxide