caa a22 4500 475790774 CHVBK 20180406123710.0 cr unu---uuuuu 170329e20000401xx s 000 0 eng 10.1007/s004230050265 doi (NATIONALLICENCE)springer-10.1007/s004230050265 Evaluation of the effects of a pneumoperitoneum with carbon dioxide or helium in a porcine model of endotoxemia [Elektronische Daten] [M. Nagelschmidt, U. Holthausen, H. Goost, Z. X. Fu, T. Minor, H. Troidl, E. Neugebauer] Abstract : Background: The expansion of the laparoscopic techniques to the critically ill patient is currently under debate. In order to evaluate the potential risks of performing laparoscopy in a body with signs of sepsis, the effects of the pneumoperitoneum were studied in a porcine model of mild endotoxemia. Methods: Twenty-eight pigs were separated into four groups of seven animals: untreated control (C), 2 µg/kg/h endotoxin (E), endotoxin and a pneumoperitoneum (3 h, 15 mmHg) with CO2 (EC) or with helium (EH). Hemodynamic and homeostatic variables were studied for a period of 5.5 h. Primary endpoints were arterial and mucosal pH and the ATP content of the bowel wall. Statistical evaluation was performed using analysis of variance and the Bonferroni test. Results: Endotoxin infusion induced characteristic symptoms of early sepsis: increase of arterial CO2, pulmonary arterial, portal venous, and pulmonary artery wedge pressure, and decrease of arterial pressure, cardiac output, arterial and mucosal pH. An additional pneumoperitoneum led to aggravation of all criteria with significant alterations in arterial and mucosal pH, arterial CO2, wedge and portal venous pressure. The most striking derangement of mean values was observed for mucosal pH (EC: 7.40, EH: 7.54) and arterial pH (EC: 7.15, EH: 7.18). In group EC, two animals died in septic shock. Conclusion: Applying a pneumoperitoneum during an ongoing sepsis significantly deteriorates hemodynamic and homeostatic variables, thus enhancing the risk of severe complications. Springer-Verlag Berlin Heidelberg, 2000 Key words Gas laparoscopy nationallicence Pneumoperitoneum nationallicence Endotoxemia nationallicence Sepsis nationallicence Porcine model nationallicence Carbon dioxide nationallicence Helium nationallicence Laparoscopy in critically ill patients nationallicence Hemodynamics nationallicence Acid-base balance nationallicence Nagelschmidt M. Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany Tel.: +49-221-989570; Fax: +49-221-9895730, DE aut Holthausen U. Surgical Clinic, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany, DE aut Goost H. Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany Tel.: +49-221-989570; Fax: +49-221-9895730, DE aut Fu Z. X. Department of General Surgery, First Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing 400016, V.A.R., CN aut Minor T. Division of Surgical Research, Department of Surgery, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany, DE aut Troidl H. Surgical Clinic, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany, DE aut Neugebauer E. Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany Tel.: +49-221-989570; Fax: +49-221-9895730, DE aut https://doi.org/10.1007/s004230050265 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004230050265 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Nagelschmidt M. Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany Tel.: +49-221-989570; Fax: +49-221-9895730, DE aut NATIONALLICENCE 700 1- Holthausen U. Surgical Clinic, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany, DE aut NATIONALLICENCE 700 1- Goost H. Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany Tel.: +49-221-989570; Fax: +49-221-9895730, DE aut NATIONALLICENCE 700 1- Fu Z. X. Department of General Surgery, First Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing 400016, V.A.R., CN aut NATIONALLICENCE 700 1- Minor T. Division of Surgical Research, Department of Surgery, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany, DE aut NATIONALLICENCE 700 1- Troidl H. Surgical Clinic, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany, DE aut NATIONALLICENCE 700 1- Neugebauer E. Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, D-51109 Cologne, Germany Tel.: +49-221-989570; Fax: +49-221-9895730, DE aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer