The effect of experimentally induced abdominal compartment sndrome on gastroesophagial reflux and pulmonary aspiration

Aim: The aim of this study was to determine the effect of increased intra-abdominal pressure on gastroesophagial reflux and pulmonary aspiration in abdominal compartman syndrome.Materials and Methods: This study was planned as experimental study. Six adult male mixed breed dogs weighed 22-26 kg were included in the study. All dogs were intubated under general anaesthesia. A plastic catheter was intraperitonally placed. While increasing the intraabdominal pressure by this catheter with normal saline solution, intraabdominal pressure was measured by means of a three-way connector. The place of another tube which was orally inserted to the stomach was confirmed by trans-abdominal palpation. Scintigraphic substance was given through this tube. Sulphur colloid after marking with 5 mCi Tc99m then mixing with 30 ml milk was given by orogastric catheter. The catheter was washed in 20 ml water. Serial dynamic scintigraphic images were obtained when intraabdominal pressure reached to 40 cm H2O increasing 2 cm H2O at every five minutes. Dogs were kept at compartment pressure for three hours then static scintigraphic images were recorded. At the end of study, from the dogs had scintigraphic images the basic, the onset of gastroesophagial reflux, the pressures at gastric contents reached to pharynx pressure and dogs showed aspiration were determined.Results: Measured basic intraabdominal pressures were under 10 cm H2O. The mean intraabdominal pressure that gastoesophagial reflux observed was measured to be as 17.83±4.07 cm H2O (11-23 cm H2O). The mean intraabdominal pressure that gastric contents reached to phyranx was measured as 29.83±3.25 cm H2O (26-35 cm H2O). In two dogs aspiration positive scintigraphic images were observed.Conclusion: The mortality rate can persist high in condition where the early diagnosis and treatment of abdominal compartment syndrome was not performed. Gastroesophagial reflux and pulmonary aspiration may be seen in these patients even in pressures that does not require surgical decompression. Inflated cuffed endotracheal tubes can not prevent aspiration. In abdominal compartment syndrome the restrictive lung damage due to mechanical pressure by increased intraabdominal pressure together with lung aspiration may elevate the mortality and permanent lung damage in these patients.