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New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery.

Derikx JP, van Waardenburg DA, Thuijls G, Willigers HM, Koenraads M, van Bijnen AA, Heineman E, Poeze M, Ambergen T, van Ooij A, van Rhijn LW, Buurman WA - PLoS ONE (2008)

Bottom Line: Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP.Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively).These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Hospital Maastricht & Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, Maastricht, the Netherlands.

ABSTRACT

Background: Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery.

Methodology/principal findings: Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (P(r)CO2, P(r-a)CO2-gap). Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively). Furthermore, circulating I-FABP correlated with gastric mucosal P(r)CO2, P(r-a)CO2-gap measured at the same time points (0.553 (p = 0.040), 0.585 (p = 0.028), respectively).

Conclusions/significance: This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

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Related in: MedlinePlus

Time course of mean (SEM) plasma I-FABP (a) and I-BABP (b) levels in children undergoing spinal fusion surgery (n = 20).* p<0.05 vs. baseline values.
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pone-0003954-g001: Time course of mean (SEM) plasma I-FABP (a) and I-BABP (b) levels in children undergoing spinal fusion surgery (n = 20).* p<0.05 vs. baseline values.

Mentions: The plasma concentration of I-FABP increased rapidly after the initiation of surgery from a mean (SEM) baseline value of 221 (32) pg/ml shortly before start of surgery, under anaesthesia (in-house mean normal value: 106 pg/ml, range: 41-336 pg/ml) to 348 (44) pg/ml at 2 hours after the onset of surgery (p = 0.006) (Figure 1a). Thereafter, the mean plasma levels increased further to 369 (33) pg/ml (p<0.001) at 4 hours after initiation of surgery. The peak value of 443 (69) pg/ml (p<0.001) was reached at 6 hours after the start of surgery, which often represented the end of surgery. Thirteen patients showed an increase in plasma I-FABP levels of at least twofold during surgery; while 7 patients had relatively unchanged circulating I-FABP values. Plasma concentrations of I-FABP decreased towards baseline values from 2 hours after the end of surgery onwards.


New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery.

Derikx JP, van Waardenburg DA, Thuijls G, Willigers HM, Koenraads M, van Bijnen AA, Heineman E, Poeze M, Ambergen T, van Ooij A, van Rhijn LW, Buurman WA - PLoS ONE (2008)

Time course of mean (SEM) plasma I-FABP (a) and I-BABP (b) levels in children undergoing spinal fusion surgery (n = 20).* p<0.05 vs. baseline values.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2599890&req=5

pone-0003954-g001: Time course of mean (SEM) plasma I-FABP (a) and I-BABP (b) levels in children undergoing spinal fusion surgery (n = 20).* p<0.05 vs. baseline values.
Mentions: The plasma concentration of I-FABP increased rapidly after the initiation of surgery from a mean (SEM) baseline value of 221 (32) pg/ml shortly before start of surgery, under anaesthesia (in-house mean normal value: 106 pg/ml, range: 41-336 pg/ml) to 348 (44) pg/ml at 2 hours after the onset of surgery (p = 0.006) (Figure 1a). Thereafter, the mean plasma levels increased further to 369 (33) pg/ml (p<0.001) at 4 hours after initiation of surgery. The peak value of 443 (69) pg/ml (p<0.001) was reached at 6 hours after the start of surgery, which often represented the end of surgery. Thirteen patients showed an increase in plasma I-FABP levels of at least twofold during surgery; while 7 patients had relatively unchanged circulating I-FABP values. Plasma concentrations of I-FABP decreased towards baseline values from 2 hours after the end of surgery onwards.

Bottom Line: Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP.Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively).These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Hospital Maastricht & Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, Maastricht, the Netherlands.

ABSTRACT

Background: Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery.

Methodology/principal findings: Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (P(r)CO2, P(r-a)CO2-gap). Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively). Furthermore, circulating I-FABP correlated with gastric mucosal P(r)CO2, P(r-a)CO2-gap measured at the same time points (0.553 (p = 0.040), 0.585 (p = 0.028), respectively).

Conclusions/significance: This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

Show MeSH
Related in: MedlinePlus