Optimal pressure of abdominal gas insufflation for bleeding control in a severe swine splenic injury model. J Surg Res 2013 Oct;184(2):931-6
Date
04/03/2013Pubmed ID
23545409DOI
10.1016/j.jss.2013.03.016Scopus ID
2-s2.0-84883859090 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
BACKGROUND: We previously demonstrated that abdominal gas insufflation (AGI) reduces intra-abdominal bleeding. To date, this is the only method that holds promise for reducing mortality from internal bleeding in a pre-hospital setting. We aimed to assess the optimal AGI pressure and the effectiveness of a portable miniaturized insufflator in abdominal bleeding control.
MATERIALS AND METHODS: We randomized 15 Yorkshire swine to receive AGI of 20, 25 or 30 mm Hg after sustaining a standardized severe splenic injury, to determine the ideal pressure for optimal bleeding control. We randomized six (40%) to insufflation with a custom-designed, battery-operated, 7-oz portable CO2 tank, whereas we used a standard laparoscopic insufflator for the remainder. Intravenous fluid boluses were administered as needed to maintain a mean arterial pressure of >60 mm Hg. At 30 min, the animals were re-laparotomized and their hemoperitoneum was quantified.
RESULTS: Target peritoneal pressures were achieved and maintained successfully with both insufflation methods. There was a trend toward greater blood loss and fluid requirements in the 30-mmHg group (P = 0.71 and 0.97, respectively). Increasing the AGI led to less predictable blood loss and fluid resuscitation requirements, as well as worsening of tissue perfusion markers (pH and lactate), likely because of iatrogenic abdominal compartment syndrome.
CONCLUSIONS: All target peritoneal pressures were easily and reliably achieved with the portable CO2 insufflator. Abdominal gas insufflation produced optimal bleeding control at 20 mm Hg. This technology could be used in a pre-hospital setting to control otherwise lethal hemorrhage at pressures typically used for standard laparoscopic surgery and proven to be safe.
Author List
Kasotakis G, Duggan M, Li Y, O'Dowd D, Baldwin K, de Moya MA, King DR, Alam HB, Velmahos GAuthor
Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AbdomenAnimals
Carbon Dioxide
Female
Hemorrhage
Insufflation
Laparoscopy
Models, Animal
Pressure
Spleen
Swine
Trauma Severity Indices
Treatment Outcome