Carbon dioxide pneumoperitoneum prevents mortality from sepsis

Abstract

Abdominal insufflation with CO2, but not helium or air, significantly reduces mortality among animals with LPS-induced sepsis. Furthermore, CO2 pneumoperitoneum rescues animals from abdominal sepsis after a laparotomy. Because IL-10 is known to downregulate TNF-alpha, the increase in IL-10 and the decrease in TNF-alpha found among the CO2-insufflated animals in our study provide evidence for a mechanism whereby CO2 pneumoperitoneum reduces mortality via IL-10-mediated downregulation of TNF-alpha.

NF-κB Links CO2 Sensing to Innate Immunity and Inflammation in Mammalian Cells

“…Our observations are consistent with those made by both Takeshita et al (12) and Wang et al (22). In mammalian models, the beneficial immunomodulatory effects of CO 2 have been demonstrated in acute respiratory distress syndrome, hypercapnic acidosis, and sepsis (7,8,26). In Drosophila, increased susceptibility to bacterial infection at elevated CO 2 is independent of pH change (9).…”

Gas-related impact of pneumoperitoneum on systemic wound healing

“…In the clinical setting however, the use of helium as insufflation gas offered no advantages with regard to peritoneal macrophage phagocytosis [27]. Interestingly, a more recent investigation using an animal model of lipopolysaccharide-induced sepsis even found a protective effect of CO 2 insufflation when compared to helium [28]. As for the gas-related influence on wound healing within the peritoneal cavity, our previous animal experiments revealed no benefit for helium laparoscopy as compared to CO 2 [4,29].…”

Involvement of Proton-Sensing TDAG8 in Extracellular Acidification-Induced Inhibition of Proinflammatory Cytokine Production in Peritoneal Macrophages

“…These anti-inflammatory actions appear to occur through peritoneal acidosis and resulted in improved survival in an animal model of sepsis (10). It should be noted, however, that the decreased production of proinflammatory cytokines may be disadvantageous for the antitumor actions of macrophages because proinflammatory cytokines also exhibit a cytotoxic action against cancer cells (26).…”

“…As for macrophages, the acidification-induced modulation of the cell functions has been implicated to be involved in less surgical trauma in laparoscopic surgery compared with an operation through a laparotomy (8,9). Thus, abdominal insufflation with CO 2 decreased LPS-induced TNF-␣ production from peritoneal macrophages and the serum TNF-␣ level in association with a pH decrease in the abdominal cavity (8,9) and prevented mortality from LPS-induced sepsis in animal models (10). Acidification of the peritoneal cavity by buffered acidic lavage solutions other than CO 2 pneumoperitoneum also reduced the serum TNF-␣ levels (9).…”