BLOCKADE OF TRANSDIAPHRAGMATIC LYMPHATIC ABSORPTION REDUCED SYSTEMIC INFLAMMATORY RESPONSE SYNDROME DURING EXPERIMENTAL PERITONITIS - EVALUATION WITH BODY OXYGEN KINETICS IN RATS

Objective: To assess the effect of blockade of transdiaphragmatic lymp hatic absorption of infected peritoneal fluid on systemic inflammatory response syndrome during experimental peritonitis by evaluating body oxygen kinetics in rats.Design: Randomised controlled experimental stu dy. Setting: Teaching hospital, Turkey. Material: 30 Wistar-albino rat s, 10 in each group. Interventions: Control group, sham laparotomy; pe ritonitis alone group, faecal peritonitis induced by caecal puncture; and lymphatic blockade and peritonitis group, transdiaphragmatic lymph atic absorption was blocked by fibrosis created by a sheet of braided polyester (Mersilene) mesh, and peritonitis induced with caecal punctu re. Main outcome measures: Aerobic culture of peritoneal contents and blood. Arterial and mixed venous blood gas analysis, plasma lactate co ncentrations. Indicators of body oxygen kinetics were calculated from these variables. Results: Bacterial peritonitis was detectable in all 20 animals in the experimental groups. Blood cultures grew pathogens i n 9/10 animals in the peritonitis alone group and 4/10 in the lymphati c blockade group (p = 0.057). Among the measured blood gas variables t here were significant differences in PvO(2) (p = 0.006) and in PaCO2 ( p = 0.02), and as indicators of tissue perfusion and acidosis there we re significant differences in ail calculated blood gas variables and i n plasma lactate concentration (p = 0.0001) between the two experiment al groups. Hypoxia as judged by the oxygen utilisation coefficient of over 0.5 and oxygen saturation of mixed venous blood of less than 50%, eight animals were hypoxic in the peritonitis alone group compared wi th one in the lymphatic blockade group (p = 0.006). Conclusion: Animal s in which transdiaphragmatic drainage was obstructed had fewer positi ve blood cultures and better body oxygen balance during peritonitis, i ndicating that blockade of transdiaphragmatic lymphatic absorption of peritoneal contents reduced systemic inflammatory response syndrome.