Document Detail


Abdominal insufflation for control of bleeding after severe splenic injury.
MedLine Citation:
PMID:  17693825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To date, there is no rapid method to control intracavitary bleeding without an operation. Over 70% of trauma deaths from uncontrollable internal bleeding occur early after injury before an operation is feasible. Abdominal insufflation (AI) by carbon dioxide has been shown to reduce the rate of bleeding after intra-abdominal injury in pigs. The concept was proven in highly lethal models of severe vascular and liver injuries. Similar injuries in humans would result in immediate exsanguination and low likelihood for any intervention. We hypothesized that AI would similarly reduce bleeding in a model of moderate but persistent bleeding from a splenic injury. This model represents a clinically relevant scenario of continuous bleeding, which does not kill the patient immediately but may ultimately result in death if not managed early. METHODS: A new model of splenic injury was applied on 19 pigs, randomized to standard resuscitation (SR, N = 10) or standard resuscitation with AI to 20 cm H2O (SRAI, N = 9). For 30 minutes, the pigs were bled and the hemodynamics recorded. At 30 minutes, the abdomen was opened and free blood was collected and measured. Outcomes were blood loss, mean arterial pressure, hemoglobin, lactate levels, and arterial blood gases at the end of the experiment. RESULTS: All pigs survived to the end of the experiment. Blood loss was lower (1,114 +/- 486 mL vs. 666 +/- 323 mL, p = 0.03) and final mean arterial pressure higher (64 +/- 12 mm Hg vs. 54 +/- 8 mm Hg, p = 0.04) in SRAI when compared with those in SR animals. Heart rate, arterial blood gases, oxygen saturation, hemoglobin, and lactate levels were similar in the two groups, except there was a more acidotic pH among SRAI animals (7.27 +/- 0.06 vs. 7.47 +/- 0.21, p = 0.02). CONCLUSIONS: AI is a novel method to control intra-abdominal bleeding temporarily. With proper portable instruments and first-responder training, this is a technique that can potentially be used in the field to save lives from intra-abdominal exsanguination.
Authors:
George C Velmahos; Konstantinos Spaniolas; Michael Duggan; Hasan B Alam; Malek Tabbara; Marc de Moya; Kirby Vosburgh
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The Journal of trauma     Volume:  63     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-13     Completed Date:  2007-09-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  285-8; discussion 288-90     Citation Subset:  AIM; IM    
Affiliation:
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, The Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. gvelmahos@partners.org
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Chemical Analysis
Carbon Dioxide / pharmacology
Disease Models, Animal
Female
Gastrointestinal Hemorrhage / mortality*,  therapy*
Hemostatic Techniques
Injury Severity Score
Insufflation / methods*
Male
Probability
Random Allocation
Resuscitation / methods
Sensitivity and Specificity
Spleen / injuries*
Survival Rate
Swine
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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