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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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Area under the curve of plasma I-FABP values (AUCI-FABP) during surgery for six patients with early complications and 14 patients without complications.Mean AUCI-FABP was significantly higher in patients with complications than in patients without complications (p = 0.032). The horizontal lines indicate the mean AUCI-FABP.
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pone-0003954-g004: Area under the curve of plasma I-FABP values (AUCI-FABP) during surgery for six patients with early complications and 14 patients without complications.Mean AUCI-FABP was significantly higher in patients with complications than in patients without complications (p = 0.032). The horizontal lines indicate the mean AUCI-FABP.

Mentions: The mean AUCI-FABP for the six patients with complications was 222 pg*hr/ml (range: 0–493 pg*hr/ml), while for patients without complications the mean AUCI-FABP was 81 pg*hr/ml (range: 0–222 pg*hr/ml) (p = 0.032) (Figure 4). No significant changes were found in mean AUCI-BABP during surgery between patients with and without complications (3.1 vs. 2.0 ng*hr/ml, p = 0.341).


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)

Area under the curve of plasma I-FABP values (AUCI-FABP) during surgery for six patients with early complications and 14 patients without complications.Mean AUCI-FABP was significantly higher in patients with complications than in patients without complications (p = 0.032). The horizontal lines indicate the mean AUCI-FABP.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0003954-g004: Area under the curve of plasma I-FABP values (AUCI-FABP) during surgery for six patients with early complications and 14 patients without complications.Mean AUCI-FABP was significantly higher in patients with complications than in patients without complications (p = 0.032). The horizontal lines indicate the mean AUCI-FABP.
Mentions: The mean AUCI-FABP for the six patients with complications was 222 pg*hr/ml (range: 0–493 pg*hr/ml), while for patients without complications the mean AUCI-FABP was 81 pg*hr/ml (range: 0–222 pg*hr/ml) (p = 0.032) (Figure 4). No significant changes were found in mean AUCI-BABP during surgery between patients with and without complications (3.1 vs. 2.0 ng*hr/ml, p = 0.341).

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