title: Influence of two different levels of intra-abdominal hypertension on bacterial translocation in a porcine model.
abstract: BACKGROUND
  The purpose of the present study was to quantify bacterial translocation to mesenteric lymph nodes due to different levels of intra-abdominal hypertension (IAH; 15 vs. 30 mmHg) lasting for 24 h in a porcine model.
  
  
  METHODS
  We examined 18 anesthetized and intubated pigs (52.3 ± 4.7 kg) which were randomly allocated to three experimental groups (each n = 6) and studied over a period of 24 h. After preparation and establishing a steady state, the intra-abdominal pressure (IAP) was increased stepwise to 30 mmHg in six animals using a carbon dioxide (CO2) insufflator (IAP-30 group). In the second group, IAP was increased to 15 mmHg (IAP-15 group), while IAP remained unchanged in another six pigs (control group). Using a pulse contour cardiac output (PiCCO®) monitoring system, hemodynamic parameters as well as blood gases were recorded periodically. Moreover, peripheral and portal vein blood samples were taken for microbiological examinations. Lymph nodes from the ileocecal junction were sampled during an intra-vital laparotomy at the end of the observational period. After sacrificing the animals, bowel tissue samples and corresponding mesenteric lymph nodes (MLN) were extracted for histopathological and microbiological analyses.
  
  
  RESULTS
  Cardiac output decreased in all groups. In IAP-30 animals, volumetric preload indices significantly decreased, while those of IAP-15 pigs did not differ from those of controls. Under IAH, the mean arterial pressure (MAP) in the IAP-30 group declined, while MAP in the IAP-15 group was significantly elevated (controls unchanged). PO2 and PCO2 remained unchanged. The grade of ischemic damage of the intestines (histopathologically quantified using the Park score) increased significantly with different IAH levels. Accordingly, the amount of translocated bacteria in intestinal wall specimens as well as in MLN significantly increased with the level of IAH. Lymph node cultures confirmed the relation between bacterial translocation (BT) and IAP. The most often cultivated species were Escherichia coli, Staphylococcus, Clostridium, Pasteurella, and Streptococcus. Bacteremia was detected only occasionally in all three groups (not significantly different) showing gut-derived bacteria such as Proteus, Klebsiella, and E. coli spp.
  
  
  CONCLUSIONS
  In this porcine model, a higher level of ischemic damage and more BT were observed in animals subjected to an IAP of 30 mmHg when compared to animals subjected to an IAP of 15 mmHg or controls.
authors.affiliation: Department of Pediatric Cardiology and Intensive Care, University Children's Hospital, Hannover Medical School (MHH), Carl-Neuberg-Str, 1, 30625 Hannover, Germany. Kaussen.Torsten@mh-hannover.de.
authors.forename: Torsten
authors.initials: T
authors.lastname: Kaussen
authors.forename: Pramod Kadaba
authors.initials: PK
authors.lastname: Srinivasan
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Afify
authors.forename: Christiane
authors.initials: C
authors.lastname: Herweg
authors.forename: René
authors.initials: R
authors.lastname: Tolba
authors.forename: Joachim
authors.initials: J
authors.lastname: Conze
authors.forename: Alexander
authors.initials: A
authors.lastname: Schachtrupp