Table of Contents Author Guidelines Submit a Manuscript
BioMed Research International
Volume 2014, Article ID 857492, 8 pages
http://dx.doi.org/10.1155/2014/857492
Research Article

Moderate Intra-Abdominal Hypertension Leads to Anaerobic Metabolism in the Rectus Abdominis Muscle Tissue of Critically Ill Patients: A Prospective Observational Study

1University of Tartu, Tartu University Hospital, Clinic of Anaesthesiology and Intensive Care, Puusepa 8, 51014 Tartu, Estonia
2Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital, Teiskontie 35, PL 2000, 33521 Tampere, Finland
3Department of Surgical Sciences/Anaesthesiology and Intensive Care Medicine, University of Uppsala, Akademiska sjukhuset Building 70, 1 tr, 751 85 Uppsala, Sweden
4University of Tartu, Tartu University Hospital, Clinic of Surgery, Puusepa 8, 51014 Tartu, Estonia

Received 6 January 2014; Accepted 11 February 2014; Published 13 March 2014

Academic Editor: John J. Gildea

Copyright © 2014 Liivi Maddison et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. We hypothesize that intra-abdominal hypertension (IAH) is associated with the presence of anaerobic metabolism in the abdominal rectus muscle (RAM) tissue of critically ill patients. Methods. We included 10 adult, critically ill patients with intra-abdominal pressure (IAP) above 12 mmHg. Microdialysis catheters (CMA 60) were inserted into the RAM tissue. The samples were collected up to 72 hours after enrollment. Results. The patients’ median (IQR) APACHE II at inclusion was 29 (21–37); 7 patients were in shock. IAP was 14.5 (12.5–17.8) mmHg at baseline and decreased significantly over time, concomitantly with arterial lactate and vasopressors requirements. The tissue lactate-to-pyruvate (L/P) ratio was 49 (36–54) at the beginning of the study and decreased significantly throughout the study. Additionally, the tissue lactate, lactate-to-glucose (L/G) ratio, and glutamate concentrations changed significantly during the study. The correlation analysis showed that lower levels of pyruvate and glycerol were associated with higher MAP and abdominal perfusion pressures (APP) and that higher levels of glutamate were correlated to elevated IAP. Conclusions. Moderate IAH leads to RAM tissue anaerobic metabolism suggestive for hypoperfusion in critically ill patients. Correlation analysis supports the concept of using APP as the primary endpoint of resuscitation in addition to MAP and IAP.