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Intraperitoneal microdialysis detects intestinal leakage earlier than hemodynamic surveillance and systemic
Soeren Erik Pischke1,2,3, Stina Hødnebø1, Torjus Wester4
1Division of Emergencies and Intensive Care, Oslo, Norway.
Objective:
Anastomotic leakage is a common complication following large abdominal surgery, often developing to life-threatening abdominal sepsis due to late diagnosis. Currently, diagnostics rely on systemic hemodynamic and infection monitoring. We hypothesized that intraperitoneal microdialysis allows detection of peritonitis prior to changes in standard clinical parameters in a pig model.
Materials And Methods:
We included six pigs; five underwent intraperitoneal fecal contamination, one had sham surgery for a total of 10 h. Microdialysis was established in four intraabdominal quadrants and two hepatic lobes. All pigs were hemodynamically monitored with pulmonary artery and femoral artery catheters. Blood samples were assessed for inflammatory markers, terminal complement complex (TCC), interleukin (IL)-6, IL-10, and plasminogen activator inhibitor-1 (PAI-1).
Results:
Microdialysis showed intraperitoneal lactate increase during the first two hours after fecal contamination, which remained elevated throughout the observation time with concurrent decrease of glucose. Arterial lactate remained within reference range (<1,6mM). Systemic inflammatory markers TCC, IL-6, IL-10 and PAI-1 increased significantly after minimum four hours. Mean arterial pressure, stroke volume variation and cardiac output were not compromised the first five hours. Sham surgery did not influence any of the parameters.
Conclusion:
Intraperitoneal fecal contamination leads to a rapid and pronounced intraperitoneal increase in lactate, decrease in glucose while pyruvate and glycerol levels remain unchanged. This distinct metabolic pattern of peritoneal inflammation can be easily detected by microdialysis. Observation of this pattern may minimize time to safe diagnosis of intestinal perforations after intraperitoneal fecal contamination.
Insights
Intraperitoneal microdialysis detects early peritonitis by monitoring lactate and glucose changes, preceding systemic markers. This allows for quicker diagnosis of intestinal perforations after abdominal surgery.
Area of Science:
- Surgical Complications
- Critical Care Medicine
- Diagnostic Technologies
Background:
- Anastomotic leakage is a frequent surgical complication, potentially leading to fatal abdominal sepsis.
- Current diagnostics for abdominal sepsis rely on delayed systemic hemodynamic and infection monitoring.
- Early detection of peritonitis is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of intraperitoneal microdialysis in detecting peritonitis before changes in standard clinical parameters.
- To investigate the metabolic changes within the peritoneal cavity during early-stage sepsis using microdialysis.
- To establish a novel diagnostic approach for post-operative abdominal complications.
Main Methods:
- A pig model was used with five pigs undergoing intraperitoneal fecal contamination and one sham surgery for 10 hours.
- Microdialysis catheters were placed in four intra-abdominal quadrants and two hepatic lobes.
- Hemodynamic monitoring and assessment of systemic inflammatory markers (TCC, IL-6, IL-10, PAI-1) were performed.
Main Results:
- Intraperitoneal microdialysis revealed an early increase in lactate and decrease in glucose within two hours of fecal contamination.
- Arterial lactate levels remained within normal limits, indicating localized peritoneal inflammation.
- Systemic inflammatory markers and hemodynamic parameters showed significant changes only after a minimum of four hours.
Conclusions:
- Intraperitoneal microdialysis can detect a distinct metabolic pattern of peritoneal inflammation (increased lactate, decreased glucose) rapidly after fecal contamination.
- This early detection via microdialysis may significantly shorten the time to diagnosis for intestinal perforations.
- Microdialysis offers a promising tool for early diagnosis of peritonitis, potentially improving outcomes in abdominal surgery patients.
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