The Effects of Hemodynamic Shock and Increased Intra-abdominal Pressure on Bacterial Translocation.
Doty, James M. MD; Oda, Jun MD, PhD; Ivatury, Rao R. MD; Blocher, Charles R. BS; Christie, Gail E. PhD; Yelon, Jay A. DO; Sugerman, Harvey J. MD
Journal of Trauma-Injury Infection & Critical Care.
52(1):13-17, January 2002.
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Background : We hypothesized that hemorrhagic shock followed by the abdominal compartment syndrome (ACS) resulted in bacterial translocation (BT) from the gastrointestinal (GI) tract.
Methods : Nineteen Yorkshire swine (20-30 kg) were divided into two groups. In the experimental group, group 1 (n = 10), animals were hemorrhaged to a mean arterial pressure (MAP) of 25-30 mm Hg for a period of 30 minutes and resuscitated to baseline MAP. Subsequently, intra-abdominal pressure (IAP) was increased to 30 mm Hg above baseline by instilling sterile normal saline into the peritoneal cavity. The IAP was maintained at this level for 60 minutes. Acid/base status, gastric mucosal ph (pHi), superior mesenteric artery (SMA) blood flow, and hemodynamic parameters were measured and recorded. Blood samples were analyzed by polymerase chain reaction (PCR) for the presence of bacteria. Spleen, lymph node, and portal venous blood cultures were obtained at 24 hours. Results were analyzed by ANOVA and are reported as mean /- SEM. The second group was the control. These animals did not have the hemorrhage, resuscitation, or intra-abdominal hypertension (IAH) but were otherwise similar to the experimental group in terms of laparotomy and measured parameters.
Results : SMA blood flow in group 1 (baseline of 0.87 /- 0.10 l/min) decreased in response to hemorrhage (0.53 /- 0.10 l/min, p = 0.0001) and remained decreased with IAH (0.63 l/min /- 0.10, p = 0.0006) as compared to control and returned towards baseline (1.01 /- 0.5 l/min) on relief of IAH. pHi (baseline of 7.21 /- 0.03) was significantly decreased with hemorrhage (7.04 /- 0.03, p = 0.0003) and decreased further after IAH (6.99 /- 0.03, p = 0.0001) in group 1 compared to control, but returned toward baseline at 24 hours (7.28 /- 0.04). The mean arterial pH decreased significantly from 7.43 /- 0.01 at baseline to 7.27 /- 0.01 at its nadir within group 1 (p = 0.0001) as well as when compared to control (p = 0.0001). Base excess was also significantly decreased between groups 1 and 2 during hemorrhage (3.30 /- 0.71 vs. 0.06 /- 0.60, p = 0.001) and IAH (3.08 /- 0.71 vs. -1.17 /- 0.60, p = 0.0001). In group 1, 8 of the 10 animals had positive lymph node cultures, 2 of the 10 had positive spleen cultures, and 2 of the 10 had positive portal venous blood cultures for gram-negative enteric bacteria. Only 2 of the 10 animals had a positive PCR. In group 2, five of the nine animals had positive lymph node cultures, zero of the nine had positive spleen cultures, and one of the nine had positive portal venous blood cultures. Two of the nine animals had positive PCRs. There was no significant difference in cultures or PCR results between the two groups (Fisher's exact test, p = 0.3).
Conclusion : In this study, hemorrhage followed by reperfusion and a subsequent insult of IAH caused significant GI mucosal acidosis, hypoperfusion, as well as systemic acidosis. These changes did not appear to be associated with a significant bacterial translocation as judged by PCR measurements, tissue, or blood cultures.
(C) 2002 Lippincott Williams & Wilkins, Inc.