Positive Intrapleural Pressure with Carbon Dioxide May Limit Intraoperative Pulmonary Arterial Bleeding: Verification by Animal Model.

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic and Cardiovascular Surgery Pub Date : 2022-12-20 DOI:10.5761/atcs.oa.22-00104
Momoko Asami, Eiichi Kanai, Yoshikane Yamauchi, Yuichi Saito, Noriyuki Matsutani, Masafumi Kawamura, Yukinori Sakao
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引用次数: 1

Abstract

Purpose: Intraoperative complications, especially unexpected bleeding, are of great concern in the safety of thoracoscopic surgery. We investigated the hemostatic efficacy and safety of positive intrapleural pressure (PIP) with carbon dioxide insufflation by assessing the amount of blood loss in a pulmonary arterial hemorrhage model.

Methods: An ex vivo experimental model of saline flow into a swine vessel was created in a container simulating a chest cavity. From the results, in vivo experiments (swine model) were conducted to compare the pulmonary arterial bleeding volume while applying PIP.

Results: In the ex vivo experiment, regardless of the incision type, the outflow volumes did not significantly differ at flow pressures of 20, 30, and 40 mmHg. At each flow pressure, the outflow volumes at 10, 15, and 20 mmHg of positive pressure in the container were significantly smaller than those of the control (p = 0.027, p = 0.002, and p = 0.005, respectively). Similarly, the in vivo experiments showed that bleeding decreased as intrapleural pressure increased (slope = -0.22, F = 55.13, p <0.0001).

Conclusion: It may be possible to temporarily suppress pulmonary arterial bleeding by increasing the intrapleural pressure to 10 to 20 mmHg using carbon dioxide insufflation. This method may be an adjunctive hemostatic maneuver for intraoperative bleeding.

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胸腔内二氧化碳正压可限制术中肺动脉出血:动物模型验证。
目的:术中并发症尤其是意外出血是影响胸腔镜手术安全性的重要因素。我们通过评估肺动脉出血模型的失血量来研究胸膜内正压(PIP)联合二氧化碳注入的止血效果和安全性。方法:在模拟猪胸腔的容器中建立生理盐水流入猪血管的离体实验模型。根据实验结果,采用猪模型进行体内实验,比较应用PIP时肺动脉出血量的变化。结果:在离体实验中,无论切口类型如何,在流压为20、30和40 mmHg时,流出量无显著差异。在每个流量压力下,容器内正压为10、15和20 mmHg时的流出体积均显著小于对照组(p = 0.027、p = 0.002和p = 0.005)。同样,体内实验表明,随着胸膜内压的升高,出血减少(斜率= -0.22,F = 55.13, p)。结论:通过二氧化碳注入将胸膜内压升高到10 ~ 20 mmHg,可能暂时抑制肺动脉出血。该方法可作为术中出血的辅助止血手法。
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来源期刊
Annals of Thoracic and Cardiovascular Surgery
Annals of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-SURGERY
CiteScore
2.80
自引率
0.00%
发文量
56
审稿时长
4-8 weeks
期刊介绍: Information not localized
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