Influence of elevated intraabdominal pressure on renal artery and renal vein flow in the porcine kid

1
Influence of elevated intra-abdominal pressure on
renal artery and renal vein flow in the porcine
kidney
J. Wauters1, P. Claus2, N. Brosens1, A.
Dieudonne1, M. Malbrain2, A. Wilmer1 1 Intensive
Care Medicine, University Hospital Gasthuisberg,
Leuven, Belgium 2 Cardiac Imaging, University
Hospital Gasthuisberg, Leuven, Belgium 3
Intensive Care Unit, Ziekenhuisnetwerk Antwerpen,
Campus Stuivenberg, Antwerpen, Belgium
World Congres ACS Antwerp, March 21-24th 2007
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Introduction

• Renal perfusionand functionimpaired
  duringelevated IAP
• Renal perfusion pressure (RPPMAP-IAP) and renal
  filtration gradient (RFGMAP-2IAP) are suggested
  to be a clinical estimator of renal perfusion

Harman, Ann Surg 1982
Cheatham, J Trauma 2000
Ulyatt, Australian Anesth 1992
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Aim

• Further clarify renal venous hemodynamics during
  elevated IAP
• Correlation between RPP (MAP-IAP) orRFG (MAP
  -2IAP) and renal perfusion?
• Assess renal cortical microcirculation during
  elevated IAP with SDF (Sidetream Darkfield)

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Methods
11 pigs (453kg) 9 ml/kg.h LR HAES PiCCO CI,
GEDVI
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Methods
500µm
FOV 0.675 mm²
0 no flow 1 intermittent
flow 2 sluggish flow 3 brisk,
continuous flow
Boerma, CC 2005
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Experimental protocol
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Results
Renal flow
Urine output
a p lt 0.05 versus baseline b p lt 0.05 versus IAP
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8
Results
a p lt 0.05 versus baseline
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Results
r - 0.46 p lt 0.05
a p lt 0.05 versus baseline
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Conclusions

• Renal vein flow decreased in parallel with renal
  artery flow as IAP was elevated
• Redistribution of flow away from the kidney
• RPP and RFG only correlate moderately with renal
  perfusion
• SDF used for the first time to assess renal
  cortical microcirculation
• MFI decreased with elevated IAP

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Thank you !!!
Dr. J. Wauters1, Dr. P. Claus2, A. Dieudonne1,N.
Brosens1, K. Van Zwam1, S. Thiessen1, Dr. M.
Malbrain3, Prof. Dr. A. Wilmer1
1Medical Intensive Care Unit, 2Cardiac Imaging UZ
Gasthuisberg, Leuven, Belgium, 3Stuivenbergziekenh
uis, Antwerp, Belgium