{"id":{"repo_id":"aachen","oai_identifier":"oai:publications.rwth-aachen.de:49884"},"canonical_url":"https://search.dev.ndltd.org/etd/aachen/oai:publications.rwth-aachen.de:49884","repository":{"repo_id":"aachen","name":"RWTH Aachen University","base_url":"https://publications.rwth-aachen.de/oai2d"},"display":{"title":"Das abdominelle Kompartmentsyndrom : hämodynamische, respiratorische und histologische Auswirkungen der wiederholten intraabdominellen Druckerhöhung am Tiermodell Schwein","abstract":"BACKGROUND: According to the sparsely available casuistic data, a recurrent abdominal compartment syndrome leads to a poorer prognosis for patients. The background still remains unclear and prospective randomized studies are not to be expected. A porcine model has previously been described but so far has not been used to investigate recurrent intraabdomal hypertension (IAH). Due to impairment of pulmonary function in patients with IAH mechanical ventilation is often required. Studies investigating the adult respiratory distress syndrome (ARDS) show an advantage of assisted ventilation modes (e.g. Bilevel Intermittent Positive Airway Pressure, BIPAP) versus full mechanical ventilation regarding ventilation and perfusion of the lung, level of required sedation and influences on hemodynamics. Therefore these ventilation modes are now considered standard for ventilation in intensive care unit patients. Nevertheless there are hints that these ventilation modes may result in a worse perfusion and organ function in cases of IAH. Therefore we evaluated the following questions using the established porcine model: 1) What is the result of a repeated elevated intraabdominal pressure (IAP) (30 mmHg for 9h followed by 3h with normal intraabdominal pressure) on organ function and organ integrity? 2) What is the effect of a pressure controlled full mechanical ventilation(PCV) in comparison to an assisted ventilation with partial spontaneous breathing (BIPAP) on parameters of respiratory function, organ function and organ integrity?MATERIAL AND METHODS: With approval of the local animal welfare committee twelve analgosedated pigs were subjected to an elevated IAP (30 mmHg) by intraperitoneal CO2 insufflation over a 9 hour period followed by 3 hours of decompression. This process was performed twice. Further 8 pigs were used as a control group without elevation of IAP. Half of each group was ventilated either in BIPAP or PCV modes with similar tidal volumes and positive endexpiratory pressures. Cardiac output (CO),mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial pO2, pCO2, SO2, pH, haemoglobin concentration (Hb), peak inspiratory pressure (PIP) and urine output (UO) were recorded hourly during the investigation periods. A standardized intravenous volume application was performed whenever CO was below 70ml/min/kg using a continuous CO surveillance. A liver probe wastaken at the end of the investigation period. The animals were then euthanised and histologic specimens were taken. Statistical analysis was performed by mean +/standard error using paired and unpaired ttests. Level of significance was adjusted according to Bonferroni when necessary. Results of histological examinations were tested on the basis of median, maximum and minimum using a Mann-Whitney-U-test.RESULTS: CO in the study group remained unchanged throughout the investigation period compared to CO of the control group. although a significantly higher volume of fluid was applied to achieve a stable CO (12.700 ml vs. 7.500 ml). UO increased significantly in the study group at the end of the investigation period. Hb decreased significantly during decompression periods and throughout the entire investigation period. MAP, CVP and PIP increased significantly synchronously to elevated IAP and returned to starting values during decompression. pCO2 increased significantly whilst pO2 and SO2 decreased during periods of elevated IAP. Histopathologic findings within lung, kidney, liver and pancreas showed significantly higher graded damage in comparison with the control group. BIPAP-ventilated animals showed more lung damage and tended to have worse parameters in the blood gas analysis.CONCLUSIONS: Recurrent elevated intraabdominal pressure of 30 mmHg results in an impairment of lung function and in histopathologically verifiable damage to lung, kidney, liver and pancreas in spite of preserved cardiac output. Decompression is not related to hemodynamic instability and should be aimed for as soon as possible from a clinical view of point. In case of IAH BIPAP-ventilation may result in slightly higher pulmonary damage than pure pressure controlled full mechanical ventilation.","abstract_html":"BACKGROUND: According to the sparsely available casuistic data, a recurrent abdominal compartment syndrome leads to a poorer prognosis for patients. The background still remains unclear and prospective randomized studies are not to be expected. A porcine model has previously been described but so far has not been used to investigate recurrent intraabdomal hypertension (IAH). Due to impairment of pulmonary function in patients with IAH mechanical ventilation is often required. Studies investigating the adult respiratory distress syndrome (ARDS) show an advantage of assisted ventilation modes (e.g. Bilevel Intermittent Positive Airway Pressure, BIPAP) versus full mechanical ventilation regarding ventilation and perfusion of the lung, level of required sedation and influences on hemodynamics. Therefore these ventilation modes are now considered standard for ventilation in intensive care unit patients. Nevertheless there are hints that these ventilation modes may result in a worse perfusion and organ function in cases of IAH. Therefore we evaluated the following questions using the established porcine model: 1) What is the result of a repeated elevated intraabdominal pressure (IAP) (30 mmHg for 9h followed by 3h with normal intraabdominal pressure) on organ function and organ integrity? 2) What is the effect of a pressure controlled full mechanical ventilation(PCV) in comparison to an assisted ventilation with partial spontaneous breathing (BIPAP) on parameters of respiratory function, organ function and organ integrity?MATERIAL AND METHODS: With approval of the local animal welfare committee twelve analgosedated pigs were subjected to an elevated IAP (30 mmHg) by intraperitoneal CO2 insufflation over a 9 hour period followed by 3 hours of decompression. This process was performed twice. Further 8 pigs were used as a control group without elevation of IAP. Half of each group was ventilated either in BIPAP or PCV modes with similar tidal volumes and positive endexpiratory pressures. Cardiac output (CO),mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial pO2, pCO2, SO2, pH, haemoglobin concentration (Hb), peak inspiratory pressure (PIP) and urine output (UO) were recorded hourly during the investigation periods. A standardized intravenous volume application was performed whenever CO was below 70ml/min/kg using a continuous CO surveillance. A liver probe wastaken at the end of the investigation period. The animals were then euthanised and histologic specimens were taken. Statistical analysis was performed by mean +/standard error using paired and unpaired ttests. Level of significance was adjusted according to Bonferroni when necessary. Results of histological examinations were tested on the basis of median, maximum and minimum using a Mann-Whitney-U-test.RESULTS: CO in the study group remained unchanged throughout the investigation period compared to CO of the control group. although a significantly higher volume of fluid was applied to achieve a stable CO (12.700 ml vs. 7.500 ml). UO increased significantly in the study group at the end of the investigation period. Hb decreased significantly during decompression periods and throughout the entire investigation period. MAP, CVP and PIP increased significantly synchronously to elevated IAP and returned to starting values during decompression. pCO2 increased significantly whilst pO2 and SO2 decreased during periods of elevated IAP. Histopathologic findings within lung, kidney, liver and pancreas showed significantly higher graded damage in comparison with the control group. BIPAP-ventilated animals showed more lung damage and tended to have worse parameters in the blood gas analysis.CONCLUSIONS: Recurrent elevated intraabdominal pressure of 30 mmHg results in an impairment of lung function and in histopathologically verifiable damage to lung, kidney, liver and pancreas in spite of preserved cardiac output. Decompression is not related to hemodynamic instability and should be aimed for as soon as possible from a clinical view of point. In case of IAH BIPAP-ventilation may result in slightly higher pulmonary damage than pure pressure controlled full mechanical ventilation.","abstract_has_math":false,"creators":["Hadem, Christian"],"institution":"Publikationsserver der RWTH Aachen University","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Schachtrupp, Alexander"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2008,"date_issued":"2008","date_published":"2008","updated_at":"2026-07-30T19:40:16Z","subjects":["info:eu-repo/classification/ddc/610","Pneumoperitoneum","Medizin","Abdominelles Kompartmentsyndrom","Intraabdominelle Hypertension","Intraabdomineller Druck","Multiorgandysfunktionssyndrom","abdominal compartment syndrome","intraabdominal pressure","intraabdominal hypertension","multiorgan dysfunction syndrome"],"languages":["ger"],"rights":["info:eu-repo/semantics/openAccess"],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112452%22"],"render_values":[{"text":"https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112452%22","href":"https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112452%22","code":true}]}]},"links":{"outbound_url":"https://publications.rwth-aachen.de/record/49884","outbound_label":"Repository record","outbound_source":"dc:identifier"},"source_record":{"url":"https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A49884","prefix":"oai_dc"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Schachtrupp, Alexander"]},{"key":"dc:creator","label":"Author","values":["Hadem, Christian"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:coverage","label":"Dc Coverage","values":["DE"]},{"key":"dc:date","label":"Dc Date","values":["2008"]},{"key":"dc:publisher","label":"Institution","values":["Publikationsserver der RWTH Aachen University"]},{"key":"dc:relation","label":"Dc Relation","values":["info:eu-repo/semantics/altIdentifier/urn/urn:nbn:de:hbz:82-opus-22500"]},{"key":"dc:type","label":"Dc Type","values":["info:eu-repo/semantics/doctoralThesis","info:eu-repo/semantics/publishedVersion"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["info:eu-repo/classification/ddc/610","Pneumoperitoneum","Medizin","Abdominelles Kompartmentsyndrom","Intraabdominelle Hypertension","Intraabdomineller Druck","Multiorgandysfunktionssyndrom","abdominal compartment syndrome","intraabdominal pressure","intraabdominal hypertension","multiorgan dysfunction syndrome"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["ger"]},{"key":"dc:rights","label":"Dc Rights","values":["info:eu-repo/semantics/openAccess"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://publications.rwth-aachen.de/record/49884","https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112452%22"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["BACKGROUND: According to the sparsely available casuistic data, a recurrent abdominal compartment syndrome leads to a poorer prognosis for patients. The background still remains unclear and prospective randomized studies are not to be expected. A porcine model has previously been described but so far has not been used to investigate recurrent intraabdomal hypertension (IAH). Due to impairment of pulmonary function in patients with IAH mechanical ventilation is often required. Studies investigating the adult respiratory distress syndrome (ARDS) show an advantage of assisted ventilation modes (e.g. Bilevel Intermittent Positive Airway Pressure, BIPAP) versus full mechanical ventilation regarding ventilation and perfusion of the lung, level of required sedation and influences on hemodynamics. Therefore these ventilation modes are now considered standard for ventilation in intensive care unit patients. Nevertheless there are hints that these ventilation modes may result in a worse perfusion and organ function in cases of IAH. Therefore we evaluated the following questions using the established porcine model: 1) What is the result of a repeated elevated intraabdominal pressure (IAP) (30 mmHg for 9h followed by 3h with normal intraabdominal pressure) on organ function and organ integrity? 2) What is the effect of a pressure controlled full mechanical ventilation(PCV) in comparison to an assisted ventilation with partial spontaneous breathing (BIPAP) on parameters of respiratory function, organ function and organ integrity?MATERIAL AND METHODS: With approval of the local animal welfare committee twelve analgosedated pigs were subjected to an elevated IAP (30 mmHg) by intraperitoneal CO2 insufflation over a 9 hour period followed by 3 hours of decompression. This process was performed twice. Further 8 pigs were used as a control group without elevation of IAP. Half of each group was ventilated either in BIPAP or PCV modes with similar tidal volumes and positive endexpiratory pressures. Cardiac output (CO),mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial pO2, pCO2, SO2, pH, haemoglobin concentration (Hb), peak inspiratory pressure (PIP) and urine output (UO) were recorded hourly during the investigation periods. A standardized intravenous volume application was performed whenever CO was below 70ml/min/kg using a continuous CO surveillance. A liver probe wastaken at the end of the investigation period. The animals were then euthanised and histologic specimens were taken. Statistical analysis was performed by mean +/standard error using paired and unpaired ttests. Level of significance was adjusted according to Bonferroni when necessary. Results of histological examinations were tested on the basis of median, maximum and minimum using a Mann-Whitney-U-test.RESULTS: CO in the study group remained unchanged throughout the investigation period compared to CO of the control group. although a significantly higher volume of fluid was applied to achieve a stable CO (12.700 ml vs. 7.500 ml). UO increased significantly in the study group at the end of the investigation period. Hb decreased significantly during decompression periods and throughout the entire investigation period. MAP, CVP and PIP increased significantly synchronously to elevated IAP and returned to starting values during decompression. pCO2 increased significantly whilst pO2 and SO2 decreased during periods of elevated IAP. Histopathologic findings within lung, kidney, liver and pancreas showed significantly higher graded damage in comparison with the control group. BIPAP-ventilated animals showed more lung damage and tended to have worse parameters in the blood gas analysis.CONCLUSIONS: Recurrent elevated intraabdominal pressure of 30 mmHg results in an impairment of lung function and in histopathologically verifiable damage to lung, kidney, liver and pancreas in spite of preserved cardiac output. Decompression is not related to hemodynamic instability and should be aimed for as soon as possible from a clinical view of point. In case of IAH BIPAP-ventilation may result in slightly higher pulmonary damage than pure pressure controlled full mechanical ventilation."]},{"key":"dc:source","label":"Dc Source","values":["Aachen : Publikationsserver der RWTH Aachen University 99 S. : Ill., graph. Darst. (2008). = Aachen, Techn. Hochsch., Diss., 2008"]},{"key":"dc:title","label":"Title","values":["Das abdominelle Kompartmentsyndrom : hämodynamische, respiratorische und histologische Auswirkungen der wiederholten intraabdominellen Druckerhöhung am Tiermodell Schwein"]}]}],"canonical_facts":{"dc:contributor":["Schachtrupp, Alexander"],"dc:coverage":["DE"],"dc:creator":["Hadem, Christian"],"dc:date":["2008"],"dc:description":["BACKGROUND: According to the sparsely available casuistic data, a recurrent abdominal compartment syndrome leads to a poorer prognosis for patients. The background still remains unclear and prospective randomized studies are not to be expected. A porcine model has previously been described but so far has not been used to investigate recurrent intraabdomal hypertension (IAH). Due to impairment of pulmonary function in patients with IAH mechanical ventilation is often required. Studies investigating the adult respiratory distress syndrome (ARDS) show an advantage of assisted ventilation modes (e.g. Bilevel Intermittent Positive Airway Pressure, BIPAP) versus full mechanical ventilation regarding ventilation and perfusion of the lung, level of required sedation and influences on hemodynamics. Therefore these ventilation modes are now considered standard for ventilation in intensive care unit patients. Nevertheless there are hints that these ventilation modes may result in a worse perfusion and organ function in cases of IAH. Therefore we evaluated the following questions using the established porcine model: 1) What is the result of a repeated elevated intraabdominal pressure (IAP) (30 mmHg for 9h followed by 3h with normal intraabdominal pressure) on organ function and organ integrity? 2) What is the effect of a pressure controlled full mechanical ventilation(PCV) in comparison to an assisted ventilation with partial spontaneous breathing (BIPAP) on parameters of respiratory function, organ function and organ integrity?MATERIAL AND METHODS: With approval of the local animal welfare committee twelve analgosedated pigs were subjected to an elevated IAP (30 mmHg) by intraperitoneal CO2 insufflation over a 9 hour period followed by 3 hours of decompression. This process was performed twice. Further 8 pigs were used as a control group without elevation of IAP. Half of each group was ventilated either in BIPAP or PCV modes with similar tidal volumes and positive endexpiratory pressures. Cardiac output (CO),mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial pO2, pCO2, SO2, pH, haemoglobin concentration (Hb), peak inspiratory pressure (PIP) and urine output (UO) were recorded hourly during the investigation periods. A standardized intravenous volume application was performed whenever CO was below 70ml/min/kg using a continuous CO surveillance. A liver probe wastaken at the end of the investigation period. The animals were then euthanised and histologic specimens were taken. Statistical analysis was performed by mean +/standard error using paired and unpaired ttests. Level of significance was adjusted according to Bonferroni when necessary. Results of histological examinations were tested on the basis of median, maximum and minimum using a Mann-Whitney-U-test.RESULTS: CO in the study group remained unchanged throughout the investigation period compared to CO of the control group. although a significantly higher volume of fluid was applied to achieve a stable CO (12.700 ml vs. 7.500 ml). UO increased significantly in the study group at the end of the investigation period. Hb decreased significantly during decompression periods and throughout the entire investigation period. MAP, CVP and PIP increased significantly synchronously to elevated IAP and returned to starting values during decompression. pCO2 increased significantly whilst pO2 and SO2 decreased during periods of elevated IAP. Histopathologic findings within lung, kidney, liver and pancreas showed significantly higher graded damage in comparison with the control group. BIPAP-ventilated animals showed more lung damage and tended to have worse parameters in the blood gas analysis.CONCLUSIONS: Recurrent elevated intraabdominal pressure of 30 mmHg results in an impairment of lung function and in histopathologically verifiable damage to lung, kidney, liver and pancreas in spite of preserved cardiac output. Decompression is not related to hemodynamic instability and should be aimed for as soon as possible from a clinical view of point. In case of IAH BIPAP-ventilation may result in slightly higher pulmonary damage than pure pressure controlled full mechanical ventilation."],"dc:identifier":["https://publications.rwth-aachen.de/record/49884","https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112452%22"],"dc:language":["ger"],"dc:publisher":["Publikationsserver der RWTH Aachen University"],"dc:relation":["info:eu-repo/semantics/altIdentifier/urn/urn:nbn:de:hbz:82-opus-22500"],"dc:rights":["info:eu-repo/semantics/openAccess"],"dc:source":["Aachen : Publikationsserver der RWTH Aachen University 99 S. : Ill., graph. Darst. (2008). = Aachen, Techn. Hochsch., Diss., 2008"],"dc:subject":["info:eu-repo/classification/ddc/610","Pneumoperitoneum","Medizin","Abdominelles Kompartmentsyndrom","Intraabdominelle Hypertension","Intraabdomineller Druck","Multiorgandysfunktionssyndrom","abdominal compartment syndrome","intraabdominal pressure","intraabdominal hypertension","multiorgan dysfunction syndrome"],"dc:title":["Das abdominelle Kompartmentsyndrom : hämodynamische, respiratorische und histologische Auswirkungen der wiederholten intraabdominellen Druckerhöhung am Tiermodell Schwein"],"dc:type":["info:eu-repo/semantics/doctoralThesis","info:eu-repo/semantics/publishedVersion"]},"updated_at":"2026-07-30T19:40:16Z"}