S K Shah1,2, F Jimenez1, P A Walker1, H Xue1, T D Feeley3, K S Uray1,2, K C Norbury3, R H Stewart2, G A Laine2, C S Cox4,5. 1. Departments of Pediatric Surgery and Surgery, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 5.236, Houston, TX, 77030, USA. 2. Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA. 3. Kinetic Concepts, Inc., San Antonio, TX, USA. 4. Departments of Pediatric Surgery and Surgery, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 5.236, Houston, TX, 77030, USA. Charles.S.Cox@uth.tmc.edu. 5. Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA. Charles.S.Cox@uth.tmc.edu.
Abstract
PURPOSE: The purpose of this large-animal study was to assess the safety and effects of negative pressure therapy (NPT) when used as temporary abdominal closure in the immediate post-decompression period after abdominal compartment syndrome (ACS). METHODS: Using a hemorrhagic shock/resuscitation and mesenteric venous pressure elevation model, ACS was physiologically induced in 12 female Yorkshire swine. At decompression, animals were allocated to either NPT (n = 6) or Bogota bag (n = 6) as temporary abdominal closure and studied for a period of 48 h or until death. Outcomes measured included morbidity and mortality, as well as hemodynamic parameters, ventilator-related measurements, blood gases, coagulation factors, and organ (liver, kidney, lung, and intestinal) edema and histology at the time of death/sacrifice. RESULTS: All animals developed ACS. Early application of NPT was associated with decreases in mesenteric venous and central venous pressure, and significantly increased drainage of peritoneal fluid. In addition, there was no increase in the incidence of mortality, recurrent intra-abdominal hypertension/ACS, or any deleterious effects on markers of organ injury. CONCLUSIONS: Early application of NPT in this porcine ACS model is safe and does not appear to be associated with an increased risk of recurrent intra-abdominal hypertension. The results of this animal study suggest that the application of NPT following decompression from ACS results in greater peritoneal fluid removal and may translate into augmented intestinal edema resolution secondary to more favorable fluid flux profiles.
PURPOSE: The purpose of this large-animal study was to assess the safety and effects of negative pressure therapy (NPT) when used as temporary abdominal closure in the immediate post-decompression period after abdominal compartment syndrome (ACS). METHODS: Using a hemorrhagic shock/resuscitation and mesenteric venous pressure elevation model, ACS was physiologically induced in 12 female Yorkshire swine. At decompression, animals were allocated to either NPT (n = 6) or Bogota bag (n = 6) as temporary abdominal closure and studied for a period of 48 h or until death. Outcomes measured included morbidity and mortality, as well as hemodynamic parameters, ventilator-related measurements, blood gases, coagulation factors, and organ (liver, kidney, lung, and intestinal) edema and histology at the time of death/sacrifice. RESULTS: All animals developed ACS. Early application of NPT was associated with decreases in mesenteric venous and central venous pressure, and significantly increased drainage of peritoneal fluid. In addition, there was no increase in the incidence of mortality, recurrent intra-abdominal hypertension/ACS, or any deleterious effects on markers of organ injury. CONCLUSIONS: Early application of NPT in this porcine ACS model is safe and does not appear to be associated with an increased risk of recurrent intra-abdominal hypertension. The results of this animal study suggest that the application of NPT following decompression from ACS results in greater peritoneal fluid removal and may translate into augmented intestinal edema resolution secondary to more favorable fluid flux profiles.
Authors: Emanuel Benninger; Ludwig Labler; Burkhardt Seifert; Otmar Trentz; Michael D Menger; Christoph Meier Journal: J Surg Res Date: 2007-08-30 Impact factor: 2.192
Authors: Shinil K Shah; Fernando Jimenez; Peter A Walker; Kevin R Aroom; Hasen Xue; Teri D Feeley; Karen S Uray; Kenneth C Norbury; Randolph H Stewart; Glen A Laine; Charles S Cox Journal: Surgery Date: 2010-05-13 Impact factor: 3.982
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Authors: Ravi S Radhakrishnan; Shinil K Shah; Samuel H Lance; Hari R Radhakrishnan; Hasen Xue; Geetha L Radhakrishnan; Uma S Ramaswamy; Peter A Walker; Karen S Uray; Glen A Laine; Randolph H Stewart; Charles S Cox Journal: Crit Care Med Date: 2009-11 Impact factor: 7.598