Document Detail


Jack A. Barney Resident Research Award. Cardiopulmonary hazards of perihepatic packing for major liver injuries.
MedLine Citation:
PMID:  7491996     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Perihepatic packing has been shown to result in pathologic intra-abdominal hypertension. Although now recognized as impairing abdominal organ perfusion, the extent to which perihepatic packing affects cardiopulmonary function has not been elucidated. METHODS: We analyzed a 3-year experience with 11 patients who sustained major hepatic injuries requiring perihepatic packing to control hemorrhage. Pertinent hemodynamic indices consisting of pulmonary capillary wedge pressure (PCWP), cardiac index (CI), oxygen delivery index (DO2), and systemic vascular resistance (SVR), and pulmonary indices consisting of peak airway pressure (PAP), mean airway pressure (MAP), static compliance (CST), and PaO2/FiO2 were measured in the surgical intensive care unit immediately before and after packs were removed. RESULTS: Unpacking resulted in a significant increase in CI (3.1 +/- 0.4 to 4.2 +/- 0.6 L/min/m2), DO2 (539 +/- 41 to 689 +/- 43 mL min/m2), CST (26 +/- 6 to 36 +/- 4 mL/cm H2O), and PaO2/FiO2 (162 +/- 44 to 237 +/- 53 cm H2O), as well as a significant decrease in PAP (47 +/- 9 to 29 +/- 6 cm H2O), MAP (34 +/- 4 to 27 +/- 3 cm H2O), PCWP (21 +/- 4 to 13 +/- 3 mm Hg), and SVR (1,239 +/- 162 to 887 +/- 130 dyne/cm5). CONCLUSIONS: Abdominal compartment syndrome following temporary perihepatic packing can result in significant cardiopulmonary compromise. While perihepatic packing can be an early life-saving procedure, timely alleviation of the secondary syndrome may be critical to the ultimate salvage of patients with marginal cardiopulmonary reserve.
Authors:
D R Meldrum; F A Moore; E E Moore; J B Haenel; N Cosgriff; J M Burch
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of surgery     Volume:  170     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  1995 Dec 
Date Detail:
Created Date:  1996-01-03     Completed Date:  1996-01-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  537-40; discussion 540-2     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Denver General Hospital, Colorado 80204-4507, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Female
Hemodynamics*
Hemorrhage / therapy
Hemostatic Techniques / adverse effects*
Humans
Liver / injuries*
Male
Middle Aged
Respiratory Mechanics*
Retrospective Studies
Wounds and Injuries / therapy
Grant Support
ID/Acronym/Agency:
P50GM49222/GM/NIGMS NIH HHS

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


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