title: Moderate intra-abdominal hypertension leads to anaerobic metabolism in the rectus abdominis muscle tissue of critically ill patients: a prospective observational study.
abstract: OBJECTIVE
  We hypothesize that intra-abdominal hypertension (IAH) is associated with the presence of anaerobic metabolism in the abdominal rectus muscle (RAM) tissue of critically ill patients.
  
  
  METHODS
  We included 10 adult, critically ill patients with intra-abdominal pressure (IAP) above 12 mmHg. Microdialysis catheters (CMA 60) were inserted into the RAM tissue. The samples were collected up to 72 hours after enrollment.
  
  
  RESULTS
  The patients' median (IQR) APACHE II at inclusion was 29 (21-37); 7 patients were in shock. IAP was 14.5 (12.5-17.8) mmHg at baseline and decreased significantly over time, concomitantly with arterial lactate and vasopressors requirements. The tissue lactate-to-pyruvate (L/P) ratio was 49 (36-54) at the beginning of the study and decreased significantly throughout the study. Additionally, the tissue lactate, lactate-to-glucose (L/G) ratio, and glutamate concentrations changed significantly during the study. The correlation analysis showed that lower levels of pyruvate and glycerol were associated with higher MAP and abdominal perfusion pressures (APP) and that higher levels of glutamate were correlated to elevated IAP.
  
  
  CONCLUSIONS
  Moderate IAH leads to RAM tissue anaerobic metabolism suggestive for hypoperfusion in critically ill patients. Correlation analysis supports the concept of using APP as the primary endpoint of resuscitation in addition to MAP and IAP.
authors.affiliation: University of Tartu, Tartu University Hospital, Clinic of Anaesthesiology and Intensive Care, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Liivi
authors.initials: L
authors.lastname: Maddison
authors.affiliation: University of Tartu, Tartu University Hospital, Clinic of Anaesthesiology and Intensive Care, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Juri
authors.initials: J
authors.lastname: Karjagin
authors.affiliation: Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital, Teiskontie 35, PL 2000, 33521 Tampere, Finland ; Department of Surgical Sciences/Anaesthesiology and Intensive Care Medicine, University of Uppsala, Akademiska sjukhuset Building 70, 1 tr, 751 85 Uppsala, Sweden.
authors.forename: Jyrki
authors.initials: J
authors.lastname: Tenhunen
authors.affiliation: University of Tartu, Tartu University Hospital, Clinic of Surgery, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Ulle
authors.initials: U
authors.lastname: Kirsimägi
authors.affiliation: University of Tartu, Tartu University Hospital, Clinic of Anaesthesiology and Intensive Care, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Joel
authors.initials: J
authors.lastname: Starkopf
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D000693:Anaerobiosis; D016638:Critical Illness; D018698:Glutamic Acid / Q000097:blood; D059325:Intra-Abdominal Hypertension / Q000097:blood / Q000628:therapy; D019344:Lactic Acid / Q000097:blood; D019289:Pyruvic Acid / Q000097:blood; D017568:Rectus Abdominis / Q000378:metabolism
chemical_list: D018698:Glutamic Acid; D019344:Lactic Acid; D019289:Pyruvic Acid
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