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Effect of abdominal insufflation on parenchymal bleeding and respiratory function
Author(s) -
Kheirabadi Bijan Shams,
Crissey Jacqueline,
Deduzman Rodolfo,
Miranda Nahir,
Pusateri Anthony
Publication year - 2006
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.20.4.a654
Subject(s) - medicine , insufflation , anesthesia , hypercapnia , acidosis , abdomen , resuscitation , blood pressure , respiratory system , surgery
Hemostatic benefit of abdominal insufflation (AI) in reducing intra‐abdominal bleeding was shown previously in laparoscopic procedures involving vena cava and splenic bleeding in mechanically ventilated animals. We investigated effects of AI in nonventilated animals, which are more comparable to pre‐hospital conditions in trauma victims. Rabbits were anesthetized, instrumented and allowed to spontaneously breathe through an O 2 mask. Parenchymal bleeding was created by laceration of the spleen and the abdomen was closed. The peritoneum was insufflated with N 2 gas to 10 mmHg pressure (n=7) or left undisturbed (controls, n=7). Limited fluid resuscitation was provided and arterial blood samples were collected at 30 min intervals. Animals were monitored for 2 hrs or until death at which time blood loss was measured. AI had no tamponade effect on the splenic bleeding. Blood loss was nearly equal in both groups (39.4±6.8 vs. 38.0±3.6 ml/kg), but mortality was higher in treated animals (71%) than controls (28%). Additionally, 1 hr post‐insufflation, significant acidosis and hypercapnia developed in the insufflated bleeding animals but not in controls ( P <0.01). The 10 mmHg insufflation pressure without bleeding did not cause respiratory acidosis in preliminary rabbit tests. Therefore, the combination of hemorrhage and insufflation pressure diminished animals’ respiratory capacity to exhale CO 2 , thereby causing respiratory acidosis. In conclusion, AI does not have any hemostatic benefit in spontaneously breathing subjects with severe parenchymal bleeding and may pose an even greater risk by suppressing respiratory function.