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Beneficial effects of theophylline infusions in surgical patients with intra-abdominal hypertension

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Abstract

Background

Intra-abdominal hypertension (IAH) can cause high mortality. Recently, we found that IAH was associated with increased serum levels of adenosine and interleukin 10. Our present “hypothesis-generated study” was based on the abovementioned results.

Materials and methods

In this uncontrolled clinical trial, a total of 78 patients with IAH were enrolled representing a 13–20 mmHg range of intra-abdominal pressure (IAP). Patients requiring surgical abdominal decompression were excluded. Patients were treated with the following protocols: standard supportive therapy (ST, n = 38) or ST plus infusion with the adenosine receptor antagonist theophylline (T, n = 40). Over the 5-day measurement period, IAP was monitored continuously and serum adenosine concentration and other clinical and laboratory measurements were monitored daily. Mortality was followed for the first 30 days following the diagnosis of IAH.

Results

Mortality of ST patients was 55%, which is compatible to other studies. Serum adenosine concentration was found to be directly proportional to IAP. Of the 40 patients receiving T treatment, survival was 100%. An increased survival related to theophylline infusion correlated with improving serum concentrations of IL-10, urea, and creatinine, as well as 24-h urine output, fluid balance, mean arterial pressure, and O2Sat.

Conclusions

Adenosine receptor antagonism with T following IAH diagnosis resulted in markedly reduced mortality in patients with moderated IAH (<20 mmHg). Theophylline-associated mortality reduction may be related to improved renal perfusion and improved MAP, presumably caused by adenosine receptor blockade. Because this study was not a randomized controlled study, these compelling observations require further multicentric clinical confirmation.

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Acknowledgments

The authors thank Dr. Tamás Keresztes for providing the adenosine and to Ildikó Kovács for performing the IL-10 measurements in this work. This work was supported by the research grant of Hungarian Ministry of Health (ETT 150/2006) and OTKA 71883.

Conflicts of interest

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Authors and Affiliations

  1. Department of Surgery, Hospital de Torrevieja, Torrevieja, Spain

    Zsolt Bodnár

  2. Department of Surgery, Gyula Kenézy Teaching Hospital, Debrecen, Hungary

    Zsolt Bodnár & Zoltán Hajdu

  3. Intensive Care Unit, Gyula Kenézy Teaching Hospital, Debrecen, Hungary

    Zoltán Szentkereszty

  4. Regional Immunological Laboratory, 3rd Department of Internal Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary

    Sándor Sipka

  5. Divisions of Physician Assistant Studies and Clinical Nutrition, University of Kentucky, Lexington, KY, USA

    Gilbert A. Boissonneault

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  1. Zsolt Bodnár
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  2. Zoltán Szentkereszty
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  3. Zoltán Hajdu
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  4. Gilbert A. Boissonneault
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  5. Sándor Sipka
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Correspondence to Sándor Sipka.

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Bodnár, Z., Szentkereszty, Z., Hajdu, Z. et al. Beneficial effects of theophylline infusions in surgical patients with intra-abdominal hypertension. Langenbecks Arch Surg 396, 793–800 (2011). https://doi.org/10.1007/s00423-011-0808-5

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  • DOI: https://doi.org/10.1007/s00423-011-0808-5

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