title: Effects of hyperthermic intraoperative peritoneal lavage on intra-abdominal pressure in an experimental model of peritonitis: A randomized, controlled, blinded interventional study.
abstract: BACKGROUND
  Hyperthermic Intraoperative Peritoneal Lavage (HIPL) is useful for bacterial decontamination and prevention of hypothermia during damage-control surgery (DCS). Little is known about the effect of HIPL on intra-abdominal pressure (IAP) alone or in combination with peritonitis.
  
  
  OBJECTIVE
  To determine the effects of HIPL at graded temperatures on IAP in the context of DCS.
  
  
  METHODS
  A total of 40 rabbits randomly assigned to aseptic-thermal (AT) and peritonitis-thermal (PT) groups and subgroups underwent HIPL at 40°C, 43°C, 46°C, and 49°C. The AT subgroup assigned 40°C was the control group. HIPL was done with a volume of 100 ml/kg. Hourly IAP measurement by two independent observers who were mutually blinded was done through a peritoneal balloon pouch connected to a manometer for 12 hours.
  
  
  RESULTS
  All rabbits in group AT survived for at least 11 hours, while all the rabbits in group PT died between 4 and 8 hours. There was significant IAP rise at 4 hours in all subgroups in comparison with the control (I AT40):III AT46 (P < 0.01), IV AT49 (P < 0.001), V PT40 (P < 0.01), VI PT43 (P < 0.01), VII PT46 (P < 0.001), and P 49 (P < 0.001) except II AT43 ( P = 0.85). Multiple linear regression analysis showed a positive correlation:Coefficient of regression {r = 0.85 (AT) and r = 0.89 (PT)} and coefficient of determination {r2 = 0.73 (AT) and r2 = 0.80 (PT)}.
  
  
  CONCLUSIONS
  Our findings suggest that beyond 3°C above the normal body temperature in this species, HIPL acts synergistically with peritonitis to exacerbate intra-abdominal hypertension and is associated with a shortened survival postoperatively due to abdominal compartment syndrome.
authors.affiliation: Hail General Hospital, Hail 81451, Kingdom of Saudi Arabia, Drumheller Hospital, Drumheller, T0J 0Y1, Alberta, Canada. robertsanda@yahoo.com
authors.forename: Robert B
authors.initials: RB
authors.lastname: Sanda
authors.forename: Aslam A
authors.initials: AA
authors.lastname: Patta
authors.forename: Omer A
authors.initials: OA
authors.lastname: Omer
authors.forename: Syed
authors.initials: S
authors.lastname: Ashraf
authors.forename: Elrasheed
authors.initials: E
authors.lastname: Omar
mesh_terms: D000818:Animals; D004311:Double-Blind Method; D006358:Hot Temperature; D059325:Intra-Abdominal Hypertension / Q000503:physiopathology*; D007432:Intraoperative Period; D010533:Peritoneal Lavage / Q000009:adverse effects*; D010538:Peritonitis / Q000503:physiopathology / Q000628:therapy*; D011817:Rabbits; D011897:Random Allocation; D016037:Single-Blind Method; D015996:Survival Rate; D016896:Treatment Outcome