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

<h4>Background</h4>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.<h4>Methodology/principal findings</h4>Twenty...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Joep P M Derikx, Dick A van Waardenburg, Geertje Thuijls, Henriëtte M Willigers, Marianne Koenraads, Annemarie A van Bijnen, Erik Heineman, Martijn Poeze, Ton Ambergen, André van Ooij, Lodewijk W van Rhijn, Wim A Buurman
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2008
Materias:
R
Q
Acceso en línea:https://doaj.org/article/c51b68d9140840a7859783612d380d1a
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
Descripción
Sumario:<h4>Background</h4>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.<h4>Methodology/principal findings</h4>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).<h4>Conclusions/significance</h4>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.