Advertisement

Effects of negative-pressure therapy with and without ropivacaine instillation in the early evolution of severe peritonitis in pigs

  • Montiel Jiménez-FuertesEmail author
  • Dolores C. García-Olmo
  • Sara Puy
  • Marc Beisani
  • Francisca Planells
  • Alba Boldó
  • Jaime Ruiz-Tovar
  • Manuel Durán
  • Damián García-Olmo
Original Article

Abstract

Purpose

The abdomen is the second most common source of sepsis and secondary peritonitis, which likely lead to death. In the present study, we hypothesized that instillation of local anesthetics into the peritoneum might mitigate the systemic inflammatory response syndrome (SIRS) in the open abdomen when combined with negative-pressure therapy (NPT) to treat severe peritonitis.

Methods

We performed a study in 21 pigs applying a model of sepsis based on ischemia/reperfusion and fecal spread into the peritoneum. The pigs were randomized into three groups, and treated for 6 h as follows: Group A: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy; Group B: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy plus abdominal instillation with physiological saline solution (PSS); and Group C: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy plus peritoneal instillation with a solution of ropivacaine in PPS.

Results

A comparison between the three groups revealed no statistically significant difference for any of the parameters registered (p > 0.05), i.e., intra-abdominal pressure, blood pressure, heart rate, O2 saturation, diuresis, body temperature, and blood levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα), and c-reactive protein (CRP). In addition, histological studies of the liver, ileum, kidney and lung showed no difference between groups.

Conclusions

The use of abdominal instillation (with or without ropivacaine) did not change the effect of 6 h of NPT after sepsis in animals with open abdomen. The absence of adverse effects suggests that longer treatments should be tested.

Keywords

Sepsis Peritonitis Temporary abdominal closure Negative-pressure therapy Instillation Septic open abdomen 

Notes

Funding

This research received a specific grant from Acelity/KCI, San Antonio, TX, USA.

Compliance with ethical standards

Conflict of interest

Montiel Jiménez-Fuertes is an advisory-board member of Acelity/KCI, contributing research and expertise. All other authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Instituto de Investigación Sanitaria de la Fundación Jiménez-Díaz and by the Ethics Committee for Animal Research of Biomedical Research Institute of Lleida (IRBLleida, Spain).

All applicable international, national, and institutional guidelines for the care and use of animals were followed in this study. All procedures performed were in accordance with the ethical standards of the institution where the studies were conducted (IRBLleida, Spain).

References

  1. 1.
    Rusell JA. Management of sepsis. N Engl J Med. 2006;355:1699–713.CrossRefGoogle Scholar
  2. 2.
    Brown D, Caballero Alvarado JA. Sepsis (Septic), peritonitis. StatPearls. Treasure Island: StatPearls Publishing; 2018.Google Scholar
  3. 3.
    Kubiak BD, Albert SP, Gatto LA, Vieau CJ, Roy SK. Snyder KP A clinically applicable porcine model of septic and ischemia/reperfusion-induced shock and multiple organ injury. J Surg Res. 2011;166:e59–69.CrossRefGoogle Scholar
  4. 4.
    Kubiak BD, Albert SP, Gatto LA, Snyder KP, Maier KG, Vieau CJ, et al. Peritoneal negative pressure therapy prevents multiple organ injury in a chronic porcine sepsis and ischemia/reperfusion model. Shock. 2010;34:525–34.CrossRefGoogle Scholar
  5. 5.
    Bokesch PM, Kapural MB, Mossad EB, Cavaglia M, Appachi E, Drummond- Webb JJ, et al. Do peritoneal catheters remove pro-inflammatory cytokines after cardiopulmonary bypass in neonates? Ann Thorac Surg. 2000;70:639–43.CrossRefGoogle Scholar
  6. 6.
    Shah SK, Jimenez F, Walker PA, Xue H, Feeley TD, Uray KS, et al. Peritoneal fluid: a potential mechanism of systemic neutrophil priming in experimental intra-abdominal sepsis. Am J Surg. 2012;203:211–6.CrossRefGoogle Scholar
  7. 7.
    Moore-Olufemi SD, Xue H, Allen SJ, Moore FA, Stewart RH, Laine GA, et al. Effects of primary and secondary intra-abdominal hypertension on mesenteric lymph flow: implications for the abdominal compartment syndrome. Shock. 2005;23:571–5.PubMedGoogle Scholar
  8. 8.
    Kowal-Vern A, Ortegel J, Bourdon P, Chakrin A, Latenser BA, Kimball D, et al. Elevated cytokine levels in peritoneal fluid from burned patients with intra-abdominal hypertension and abdominal compartment syndrome. Burns. 2006;32:563–9.CrossRefGoogle Scholar
  9. 9.
    Batacchi S, Matano S, Nella A, Zagli G, Bonizzoli M, Pasquini A, et al. Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures. Crit Care. 2009;13:194–202.CrossRefGoogle Scholar
  10. 10.
    Amin AI, Shaikh IA. Topical negative pressure in managing severe peritonitis: a positive contribution? World J Gastroenterol. 2009;15((Suppl 27)):3394–7.CrossRefGoogle Scholar
  11. 11.
    Emr B, Sadowsky D, Azhar N, Gatto LA, An G, Nieman GF, et al. Removal of inflammatory ascites is associated with dynamic modification of local and systemic inflammation along with prevention of acute lung injury: in vivo and in silico studies. Shock. 2014;41:317–23.CrossRefGoogle Scholar
  12. 12.
    Batai I, Kerenyi M, Tekeres M. The impact of drugs used in anesthesia on bacteria. Eur J Anaesthesiol. 1999;16:425–40.CrossRefGoogle Scholar
  13. 13.
    Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present an potential clinical implications. Acta Anaesthesiol Scand. 2006;50:265–82.CrossRefGoogle Scholar
  14. 14.
    Schmidt W, Schmidt H, Bauer H, Gebhard MM, Martin E. Influence of lidocaine on endotoxin-induced leukocyte endothelial cell adhesion and macromolecular leakage in vivo. Anesthesiology. 1997;87:617–24.CrossRefGoogle Scholar
  15. 15.
    Jiménez-Fuertes M, Ruiz-Tovar J, Durán-Poveda M, Garcia-Olmo D. Negative pressure therapy with intraperitoneal saline instillation in the open septic abdomen. Int J Surg Res. 2016;S3(001):1–4.Google Scholar
  16. 16.
    Jiménez-Fuertes M, Costa Navarro D. Outpatient laparoscopic cholecystectomy and pain control: a series of 100 cases. Cir Esp. 2015;93(3):181–6.CrossRefGoogle Scholar
  17. 17.
    Schein M, Wittmann DH, Holzheimer R, Condon RE. Hypothesis: compartmentalization of cytokines in intraabdominal infection. Surgery. 1996;119:694–700.CrossRefGoogle Scholar
  18. 18.
    Adib-Conquy M, Cavaillon JM. Stress molecules in sepsis and systemic inflammatory response syndrome. FEBS Lett. 2007;581:3723–33.CrossRefGoogle Scholar
  19. 19.
    Brocco MC, Paulo DN, Almeida CE, Carraretto AR, Cabral SA, Silveira AC, et al. A study of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) serum levels in rats subjected to fecal peritonitis and treated with intraperitoneal ropivacaine. Acta Cir Bras. 2012;27:494–8.CrossRefGoogle Scholar
  20. 20.
    Brocco MC, Paulo DN, Baptista JF, Carraretto AR, Ferrari TA, de Azevedo TC, et al. Effects of peritoneal lavage with bupivacaine on survival of mice with fecal peritonitis. Rev Bras Anestesiol. 2008;58:474–9 (470–4).CrossRefGoogle Scholar
  21. 21.
    Brocco MC, Paulo DN, Baptista JF, Ferrari TA, Azevedo TC, Silva AL. Effects of peritoneal lavage with lidocaine on survival of rats with fecal peritonitis. Acta Cir Bras. 2008;23:42–7.CrossRefGoogle Scholar
  22. 22.
    Jannasch O, Meyer F, Fuellert A, König B, Eder F, Tautenhahn J. Vacuum-assisted closure (VAC) for postoperative secondary peritonitis: effect on bacterial load as well as local and systemic cytokine response (initial results). Pol Przegl Chir. 2018;90(5):27–35.CrossRefGoogle Scholar
  23. 23.
    Barker DE, Green JM, Maxwell RA, et al. Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J Am Coll Surg. 2007;204:784–92.CrossRefGoogle Scholar
  24. 24.
    Amin AI, Shaikh IA. Topical negative pressure in managing severe peritonitis: a positive contribution? World J Gastroenterol. 2009;15:3394–7.CrossRefGoogle Scholar
  25. 25.
    Pliakos I, Michalopoulos N, Papavramidis TS, et al. The effect of vacuum assisted closure in bacterial clearance of the infected abdomen. Surg Infect (Larchmt). 2014;15(1):18–23.CrossRefGoogle Scholar
  26. 26.
    Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Analytic review: interleukin-6 in surgery, trauma, and critical care: part I: basic science. J Intensive Care Med. 2011;26:3Y12.CrossRefGoogle Scholar
  27. 27.
    Riché F, Gayat E, Collet C, Matéo J, Laisné MJ, Launay JM, Valleur P, Payen D, Cholley BP. Local and systemic innate immune response to secondary human peritonitis. Crit Care. 2013;17:R201.CrossRefGoogle Scholar
  28. 28.
    Szilágyi B, Fejes Z, Pócsi M, Kappelmayer J, Nagy B Jr. Role of sepsis modulated circulating microRNAs. EJIFCC. 2019;30(2):1.Google Scholar
  29. 29.
    Weber JA, Baxter DH, Zhang S, Huang DY, Huang KH, Lee MJ, et al. The microRNA spectrum in 12 body fluids. Clin Chem. 2010;56:1733–41.CrossRefGoogle Scholar
  30. 30.
    Labaille T, Mazoit JX, Pauqeron X, Franco D, Benhamou D. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg. 2002;94:100–5.PubMedGoogle Scholar
  31. 31.
    Weaver JL, Matheson PJ, Matheson A, Graham VS, Downard C, Garrison RN, et al. Direct peritoneal resuscitation reduces inflammation in the kidney after acute brain death. Am J Physiol Renal Physiol. 2018;315:F406–F412412.CrossRefGoogle Scholar
  32. 32.
    Weaver JL, Matheson PJ, Matheson A, Downard CD, Garrison RN, Smith JW. Direct peritoneal resuscitation alters leukocyte infiltration in the lung after acute brain death. Shock. 2018;50:565–71.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Montiel Jiménez-Fuertes
    • 1
    Email author
  • Dolores C. García-Olmo
    • 2
  • Sara Puy
    • 2
  • Marc Beisani
    • 2
    • 3
  • Francisca Planells
    • 2
  • Alba Boldó
    • 2
  • Jaime Ruiz-Tovar
    • 1
  • Manuel Durán
    • 1
  • Damián García-Olmo
    • 4
  1. 1.Fundación Jiménez Díaz (IIS-FJD)“Rey Juan Carlos” University Hospital and Instituto de Investigación SanitariaMadridSpain
  2. 2.Centre de Recerca Experimental Biomèdica Aplicada (CREBA)IRBLleidaLleidaSpain
  3. 3.Department of SurgeryHospital del MarBarcelonaSpain
  4. 4.Department of general and Digestive SurgeryFundación Jiménez-Díaz University Hospital and Instituto de Investigación Sanitaria (IIS-FJD)MadridSpain

Personalised recommendations