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Clinically applicable porcine model of abdominal compartment syndrome

Introduction

Aggressive resuscitation in disease processes such as sepsis, peritonitis, and bowel ischemia can result in elevated intra-abdominal pressure (IAP), leading ultimately to abdominal compartment syndrome (ACS). Clinically, ACS causes organ dysfunction with oliguria, increased airway pressures, reduced oxygenation, and a fall in cardiac output (CO). There are currently no animal models that adequately mimic the complex pathophysiology associated with ACS. We have developed a clinically applicable porcine model that closely mimics the pathology seen in human patients.

Methods

Pigs (n = 3) weighing 25–28 kg were anesthetized and placed on mechanical ventilation. Bladder, venous, systemic and pulmonary arterial catheters were placed for hemodynamic monitoring, infusion of fluids and drugs, blood sampling, and to measure bladder pressure (IAP). The injury model consists of 'two hits': through a midline laparotomy, the superior mesenteric artery was occluded for 30 minutes then released to create intestinal ischemia/reperfusion injury; and the cecum was perforated, and stool collected (0.5 ml/kg) and mixed with blood (2 ml/kg) to form a fecal clot that was placed in the right lower quadrant of the peritoneal cavity. Following injury the laparotomy was closed and animals received vigorous fluid resuscitation to maintain the mean arterial pressure (>60 mmHg) and urine output (UOP) (>0.5 cm3/kg/hour), and wide-spectrum antibiotics (ampicillin 2 g and flagyl 500 mg) were administered. The abdomen was reopened 12 hours after injury, and passively drained to mimic current clinical treatment.

Results

See Figure 1.

figure1

Figure 1

Conclusion

This model accurately mimics the development of human ACS as indicated by an increasing IAP and plateau pressure (Ppl) with a decrease in oxygenation (P/F ratio), CO, and UOP.

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Kubiak, B., Albert, S., Hutchinson, G. et al. Clinically applicable porcine model of abdominal compartment syndrome. Crit Care 12, P323 (2008). https://doi.org/10.1186/cc6544

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Keywords

  • Cardiac Output
  • Flagyl
  • Superior Mesenteric Artery
  • Compartment Syndrome
  • Abdominal Compartment Syndrome