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

J.P. Derikx, D.A. van Waardenburg, G. Thuijls, H.M. Willigers, M. Koenraads, A.A. van Bijnen, E. Heineman, M. Poeze, T. Ambergen, A. van Ooij, L.W. van Rhijn, W.A. Buurman

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Abstract

PG - e3954 AB - 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
Original languageEnglish
Article numbere3954
JournalPLOS ONE
Volume3
Issue number12
DOIs
Publication statusPublished - 1 Jan 2008

Cite this

Derikx, J. P., van Waardenburg, D. A., Thuijls, G., Willigers, H. M., Koenraads, M., van Bijnen, A. A., Heineman, E., Poeze, M., Ambergen, T., van Ooij, A., van Rhijn, L. W., & Buurman, W. A. (2008). New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery. PLOS ONE, 3(12), [e3954]. https://doi.org/10.1371/journal.pone.0003954