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Effect of intraabdominal hypertension on splanchnic blood flow in children with appendicular peritonitis
Valentyna M Perova-Sharonova1,2, Andrew A Albokrinov1, Ulbolhan A Fesenko2
1Lviv Regional Children's Clinic Hospital, Lysenka Str. 31, Lviv, Ukraine.
Insights
Intraabdominal hypertension significantly reduces splanchnic blood flow in children. This study found that elevated intraabdominal pressure negatively correlates with blood flow indexes in the superior mesenteric artery and portal vein in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Surgical intensive care
Background:
- Intraabdominal hypertension (IAH) is a critical condition leading to organ hypoperfusion and potential failure.
- IAH is often underdiagnosed, particularly in pediatric populations.
- Limited data exist on the impact of intraabdominal pressure (IAP) on splanchnic circulation in children.
Purpose of the Study:
- To investigate the effect of elevated intraabdominal pressure on splanchnic blood flow in children.
- To determine the correlation between intraabdominal pressure and blood flow in the superior mesenteric artery and portal vein.
- To assess the relationship between blood flow indexes and abdominal perfusion pressure in pediatric patients with IAH.
Main Methods:
- A study involving 94 children post-appendicular peritonitis surgery.
- Patients were grouped based on intraabdominal pressure levels: with or without intraabdominal hypertension (IAH).
- Superior mesenteric artery (SMA) and portal vein (PV) blood flows were measured, calculating blood flow indexes (BFI) and abdominal perfusion pressure (APP).
Main Results:
- Children with IAH exhibited significantly lower BFI_SMA (54.38%) and BFI_PV (63.11%) compared to those without IAH.
- Strong negative correlations were observed between IAP and BFI_SMA, and weak negative correlations between IAP and BFI_PV in the IAH group.
- No significant correlations were found between blood flow indexes and APP in children with IAH.
Conclusions:
- Elevated intraabdominal pressure significantly impairs splanchnic blood flow in pediatric patients with appendicular peritonitis.
- Blood flow indexes in the SMA and PV are negatively correlated with IAP in this cohort.
- Abdominal perfusion pressure does not correlate with splanchnic blood flow in children experiencing IAH due to appendicular peritonitis.
Background And Aims:
Intraabdominal hypertension (IAH) is poorly diagnosed condition that cause splanchnic hypoperfusion and abdominal organs ischemia and can lead to multiple organ failure. There are no scientific data regarding effect of intraabdominal pressure (IAP) on splanchnic circulation in children.
Material And Methods:
Ninety-four children after surgery for appendicular peritonitis were enrolled in the study. After IAP measurement children were included in one of two groups according IAP levels: "without IAH" (n = 51) and "with IAH" (n = 43). Superior mesenteric artery (SMA) and portal vein (PV) blood flows (BFSMA, BFPV, mL/min) were measured, and SMA and PV blood flow indexes (BFISMA, BFIPV, ml/min*m2) and abdominal perfusion pressure (APP) were calculated in both groups.
Results:
Median BFISMA and BFIPV in group "with IAH" were lower by 54.38% (P < 0.01) and 63.11% (P < 0.01) respectively compared to group "without IAH". There were strong significant negative correlation between IAP and BFISMA (r s = -0.66; P < 0.0001), weak significant negative correlation between IAP and BFIPV (r s = -0.36; P = 0.0001) in group "with IAH" and weak significant negative correlation between IAP and BFISMA (r s = -0.30; P = 0.0047) in group "without IAH". There were no statistically significant correlations between IAP and BFIPV in group "without IAH", between BFISMA and APP in both groups and between BFIPV and APP in both groups.
Conclusion:
Elevated IAP significantly reduces splanchnic blood flow in children with appendicular peritonitis. BFISMA and BFIPV negatively correlate with IAP in these patients. There is no correlation between BFISMA/BFIPV and APP in children with IAH due to appendicular peritonitis.
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