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News Newsfeeds Standardized intensive care unit management in an anhepatic pig model: new standards for analyzing liver support systems
Written by Critical Care
Several anhepatic pig models were developed in the past. Most models suffer from short anhepatic survival times due to insufficient postoperative intensive care unit (ICU)-management. The aim of this study was to analyze anhepatic survival time under standardized intensive care therapy in a pig model.
Methods:
Eight pigs underwent a total hepatectomy after Y-graft interposition between the infrahepatic vena cava and the portal vein to the suprahepatic vena cava. An intracranial probe was inserted for intracranial pressure (ICP) monitoring. Animals received pressure-controlled ventilation under deep narcosis. Vital parameters were continuously recorded. Urinary output, blood gas analysis, hemoglobin, hematocrit, serum electrolytes, lactate and glucose were monitored hourly and creatinine, prothrombin time (PT), international normalised ratio (INR), serum albumin every eight hours. Sodium chloride solution 0.9%, hydroxyethylstarch 6%, fresh frozen plasma and erythrocytes units were used for volume substitution, and norepinephrine to prevent severe hypotension. Serum electrolytes and acid-base balance were corrected as required. An antibiotic prophylaxis with ceftriaxon was given daily, as well as furosemide, to maintain diuresis.
Results:
Postoperative survival was 100% after 24 hours, with a maximum survival of 73 (mean 58+/-4) hours. Hemodynamic parameters like heart rate, mean arterial pressure and pulse oximetry remained stable during surgical procedure and following anhepatic status due to ICU-therapy, until escalating at time of death. Deteriorating pulmonary function could be stabilized by increasing oxygen concentration (FiO2), positive end-expiratory pressure (PEEP) and maximal airway pressure. Furosemide was used to maintain diuresis until renal failure occurred. ICP started at 15-17 mmHg and increased continuously up to levels of 41-43 mmHg at time of death. All animals died due to multiple-organ failure.
Conclusions:
Using standardized intensive care management after total hepatectomy we were able to prolong anhepatic survival over 58 hours without the use of liver support systems. The survival benefit of liver support systems in previous animal studies should be re-evaluated against our model.
Wednesday, 21 July 2010 19:00
Introduction:Several anhepatic pig models were developed in the past. Most models suffer from short anhepatic survival times due to insufficient postoperative intensive care unit (ICU)-management. The aim of this study was to analyze anhepatic survival time under standardized intensive care therapy in a pig model.
Methods:
Eight pigs underwent a total hepatectomy after Y-graft interposition between the infrahepatic vena cava and the portal vein to the suprahepatic vena cava. An intracranial probe was inserted for intracranial pressure (ICP) monitoring. Animals received pressure-controlled ventilation under deep narcosis. Vital parameters were continuously recorded. Urinary output, blood gas analysis, hemoglobin, hematocrit, serum electrolytes, lactate and glucose were monitored hourly and creatinine, prothrombin time (PT), international normalised ratio (INR), serum albumin every eight hours. Sodium chloride solution 0.9%, hydroxyethylstarch 6%, fresh frozen plasma and erythrocytes units were used for volume substitution, and norepinephrine to prevent severe hypotension. Serum electrolytes and acid-base balance were corrected as required. An antibiotic prophylaxis with ceftriaxon was given daily, as well as furosemide, to maintain diuresis.
Results:
Postoperative survival was 100% after 24 hours, with a maximum survival of 73 (mean 58+/-4) hours. Hemodynamic parameters like heart rate, mean arterial pressure and pulse oximetry remained stable during surgical procedure and following anhepatic status due to ICU-therapy, until escalating at time of death. Deteriorating pulmonary function could be stabilized by increasing oxygen concentration (FiO2), positive end-expiratory pressure (PEEP) and maximal airway pressure. Furosemide was used to maintain diuresis until renal failure occurred. ICP started at 15-17 mmHg and increased continuously up to levels of 41-43 mmHg at time of death. All animals died due to multiple-organ failure.
Conclusions:
Using standardized intensive care management after total hepatectomy we were able to prolong anhepatic survival over 58 hours without the use of liver support systems. The survival benefit of liver support systems in previous animal studies should be re-evaluated against our model.
Authors: Christian Thiel
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