Perioperative Fluid Accumulation Impairs Intestinal Contractility to a Smilar Extent as Peritonitis and Endotoxemia

Gorrasi, José Antonio; Jakob, Stephan; Tovar, Luis Antonio; Balsiger, Bruno Markus; Brandt, Sebastian; Brügger, Lukas; Bracht, Hendrik; Takala, Jukka (2018). Perioperative Fluid Accumulation Impairs Intestinal Contractility to a Smilar Extent as Peritonitis and Endotoxemia. Shock, 50(6), pp. 735-740. Lippincott Williams & Wilkins 10.1097/SHK.0000000000001088

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BACKGROUND: Perioperative resuscitation with large amounts of fluid may cause tissue edema, especially in the gut, and thereby impair its functions. This is especially relevant in sepsis where capillaries become leaky and fluid rapidly escapes to the pericapillary tissue. We assessed the effects of endotoxemia and peritonitis, and the use of high and moderate volume fluid resuscitation on jejunal contractility. We hypothesized that both endotoxemia and peritonitis impair jejunum contractility and relaxation, and that this effect is aggravated in peritonitis and with high fluid administration. METHODS: Pigs were randomized to endotoxin (n = 16), peritonitis (n = 16), or sham operation (n = 16), and either high (20 mL/kg/h) or moderate volume (10 mL/kg/h) fluid resuscitation for 24 hours or until death. At the end of the experiment, jejunal contractility and relaxation were measured in vitro using acetylcholine and sodium nitroprusside reactivity, and the effect of nitric oxide synthase inhibition (NOS-I) was assessed. RESULTS: Mortality in the respective groups was 88% (peritonitis high), 75% (endotoxemia high), 50% (peritonitis moderate), 13% (endotoxemia moderate and sham operation high) and 0% (sham operation moderate volume resuscitation). While gut perfusion was preserved in all groups, jejunal contractility was impaired in the two peritonitis and in the two endotoxemia groups, and similarly also in the sham operation group treated with high but not with moderate volume fluid resuscitation [model-fluid-contraction-interaction, p = 0.036; maximal contractility 136 ± 28% (average of both peritonitis, both endotoxemia and sham operation high volume groups) vs. 170 ± 74% of baseline (sham operation moderate volume group)]. NOS-I reduced contractility (contraction-inhibition-interaction, p = 0.011) without significant differences between groups and relaxation was affected neither by peritonitis and endotoxemia nor by the fluid regimen. CONCLUSIONS: Intestinal contractility is similarly impaired during peritonitis and during endotoxemia. Moreover, perioperative high volume fluid resuscitation in sham operated animals also decreases intestinal contractility. This may have consequences for post-operative recovery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Pavillon 52 > Forschungsgruppe Intensivmedizin
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR)

UniBE Contributor:

Gorrasi, José Antonio; Jakob, Stephan; Tovar, Luis Antonio; Balsiger, Bruno Markus; Brandt, Sebastian; Brügger, Lukas; Bracht, Hendrik and Takala, Jukka

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1073-2322

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

26 Jan 2018 10:53

Last Modified:

15 Nov 2018 01:30

Publisher DOI:

10.1097/SHK.0000000000001088

PubMed ID:

29251668

BORIS DOI:

10.7892/boris.109069

URI:

https://boris.unibe.ch/id/eprint/109069

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