Skip to main content
main-content

01.08.2010 | Research | Ausgabe 4/2010 Open Access

Critical Care 4/2010

Standardized intensive care unit management in an anhepatic pig model: new standards for analyzing liver support systems

Zeitschrift:
Critical Care > Ausgabe 4/2010
Autoren:
Christian Thiel, Karolin Thiel, Alexander Etspueler, Thomas Schenk, Matthias H Morgalla, Alfred Koenigsrainer, Martin Schenk
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​cc9196) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

CT conceived of the study and coordinated the study group and as a surgeon he operated the pigs. KT participated in the design if the study and coordination and helped to draft the manuscript and as a surgeon she operated the pigs. AE as an anaesthesiologist carried out the intensive care therapy. TS was involved in the neurological measurement of the pigs. MM as a neurosurgeon participated in the design of the study concerning neurological aspects and placed the cranial probes. AK helped to draft the manuscript. MS designed the study and performed the statistical analysis. All authors read and approved the final manuscript.

Abstract

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 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, haemoglobin, hematocrit, serum electrolytes, lactate, and glucose were monitored hourly, and creatinine, prothrombin time, international normalised ratio, and serum albumin were monitored every 8 hours. Sodium chloride solution 0.9%, hydroxyethyl starch 6%, fresh frozen plasma, and erythrocyte units were used for volume substitution, and norepinephrine was used to prevent severe hypotension. Serum electrolytes and acid-base balance were corrected as required. 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. Haemodynamic parameters such as heart rate, mean arterial pressure, and pulse oximetry remained stable during surgical procedures and following anhepatic status due to ICU therapy until escalating at time of death. Deteriorating pulmonary function could be stabilized by increasing oxygen concentration, positive end-expiratory pressure, 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 as a result of 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 reevaluated against our model.
Zusatzmaterial
Additional file 1: ICU Management. Algorithms for volume resuscitation, vasopressor support and management of mechanical ventilation. (DOC 27 KB)
13054_2010_8604_MOESM1_ESM.DOC
Additional file 2: Course of haemodynamic parameters and electrolytes. Haemodynamic parameters, electrolytes and body temperature with respect to time and resuscitation. (DOC 42 KB)
13054_2010_8604_MOESM2_ESM.DOC
Additional file 3: Course of ventilation parameters. Ventilation parameters and body temperature with respect to time and resuscitation. (DOC 39 KB)
13054_2010_8604_MOESM3_ESM.DOC
Authors’ original file for figure 1
13054_2010_8604_MOESM4_ESM.pdf
Authors’ original file for figure 2
13054_2010_8604_MOESM5_ESM.pdf
Authors’ original file for figure 3
13054_2010_8604_MOESM6_ESM.pdf
Authors’ original file for figure 4
13054_2010_8604_MOESM7_ESM.pdf
Authors’ original file for figure 5
13054_2010_8604_MOESM8_ESM.pdf
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 4/2010

Critical Care 4/2010 Zur Ausgabe

Neu im Fachgebiet AINS

Meistgelesene Bücher aus dem Fachgebiet AINS

  • 2014 | Buch

    Komplikationen in der Anästhesie

    Fallbeispiele Analyse Prävention

    Aus Fehlern lernen und dadurch Zwischenfälle vermeiden! Komplikationen oder Zwischenfälle in der Anästhesie können für Patienten schwerwiegende Folgen haben. Häufig sind sie eine Kombination menschlicher, organisatorischer und technischer Fehler.

    Herausgeber:
    Matthias Hübler, Thea Koch
  • 2013 | Buch

    Anästhesie Fragen und Antworten

    1655 Fakten für die Facharztprüfung und das Europäische Diplom für Anästhesiologie und Intensivmedizin (DESA)

    Mit Sicherheit erfolgreich in Prüfung und Praxis! Effektiv wiederholen und im entscheidenden Moment die richtigen Antworten parat haben - dafür ist dieses beliebte Prüfungsbuch garantiert hilfreich. Anhand der Multiple-Choice-Fragen ist die optimale Vorbereitung auf das Prüfungsprinzip der D.E.A.A. gewährleistet.

    Autoren:
    Prof. Dr. Franz Kehl, Dr. Hans-Joachim Wilke
  • 2011 | Buch

    Pharmakotherapie in der Anästhesie und Intensivmedizin

    Wie und wieso wirken vasoaktive Substanzen und wie werden sie wirksam eingesetzt Welche Substanzen eignen sich zur perioperativen Myokardprojektion? 
    Kenntnisse zur Pharmakologie und deren Anwendung sind das notwendige Rüstzeug für den Anästhesisten und Intensivmediziner. Lernen Sie von erfahrenen Anästhesisten und Pharmakologen.

    Herausgeber:
    Prof. Dr. Peter H. Tonner, Prof. Dr. Lutz Hein
  • 2013 | Buch

    Anästhesie und Intensivmedizin – Prüfungswissen

    für die Fachpflege

    Fit in Theorie, Praxis und Prüfung! In diesem Arbeitsbuch werden alle Fakten der Fachweiterbildung abgebildet. So können Fachweiterbildungsteilnehmer wie auch langjährige Mitarbeiter in der Anästhesie und Intensivmedizin ihr Wissen gezielt überprüfen, vertiefen und festigen.

    Autor:
    Prof. Dr. Reinhard Larsen

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update AINS und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise