Intraoperative Blutungen in der Thoraxchirurgie

Schirren, Moritz; Sponholz, Stefan; Oguhzan, S.; Kudelin, N; Ruf, C.; Trainer, S.; Schirren, J.

doi:10.1007/s00104-015-2999-8

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Currently, it is not known how these positions compare with respect to the distribution of regional pulmonary perfusion and gas exchange. Furthermore, during thoracic surgery, the incidence of major bleeding leading to acute intravascular hypovolemia can reach up to 5% (Schirren et al, 2015). It has been proposed that acute intravascular hypovolemia may alter hypoxic pulmonary vasoconstriction (Deem et al, 1995) and thereby gas exchange.…”

Section: Introductionmentioning

confidence: 99%

Effects of Body Position and Hypovolemia on the Regional Distribution of Pulmonary Perfusion During One-Lung Ventilation in Endotoxemic Pigs

et al. 2021

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Background: The incidence of hypoxemia during one-lung ventilation (OLV) is as high as 10%. It is also partially determined by the distribution of perfusion. During thoracic surgery, different body positions are used, such as the supine, semilateral, lateral, and prone positions, with such positions potentially influencing the distribution of perfusion. Furthermore, hypovolemia can impair hypoxic vasoconstriction. However, the effects of body position and hypovolemia on the distribution of perfusion remain poorly defined. We hypothesized that, during OLV, the relative perfusion of the ventilated lung is higher in the lateral decubitus position and that hypovolemia impairs the redistribution of pulmonary blood flow.Methods: Sixteen juvenile pigs were anesthetized, mechanically ventilated, submitted to a right-sided thoracotomy, and randomly assigned to one of two groups: (1) intravascular normovolemia or (2) intravascular hypovolemia, as achieved by drawing ~25% of the estimated blood volume (n = 8/group). Furthermore, to mimic thoracic surgery inflammatory conditions, Escherichia coli lipopolysaccharide was continuously infused at 0.5 μg kg−1 h−1. Under left-sided OLV conditions, the animals were further randomized to one of the four sequences of supine, left semilateral, left lateral, and prone positioning. Measurements of pulmonary perfusion distribution with fluorescence-marked microspheres, ventilation distribution by electrical impedance tomography, and gas exchange were then performed during two-lung ventilation in a supine position and after 30 min in each position and intravascular volume status during OLV.Results: During one-lung ventilation, the relative perfusion of the ventilated lung was higher in the lateral than the supine position. The relative perfusion of the non-ventilated lung was lower in the lateral than the supine and prone positions and in semilateral compared with the prone position. During OLV, the highest arterial partial pressure of oxygen/inspiratory fraction of oxygen (PaO2/FIO2) was achieved in the lateral position as compared with all the other positions. The distribution of perfusion, ventilation, and oxygenation did not differ significantly between normovolemia and hypovolemia.Conclusions: During one-lung ventilation in endotoxemic pigs, the relative perfusion of the ventilated lung and oxygenation were higher in the lateral than in the supine position and not impaired by hypovolemia.

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Section: Introductionmentioning

confidence: 99%

Effects of Body Position and Hypovolemia on the Regional Distribution of Pulmonary Perfusion During One-Lung Ventilation in Endotoxemic Pigs

et al. 2021

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“…This should be avoided as it may enlarge the defect through the compression. This procedure was already used by Schirren et al ( 4 , 5 ) and favoured for the treatment of injuries to the pulmonary artery. To be able to close the defect, the finger must be removed during suturing, resulting in more bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Balloons that are too large should not be inserted into the defect, as they may occlude the atrium, leading in turn to circulatory failure ( 6 , 7 ). If, as in the third group, an attempt was made to close the defect with a clamp, it can happen that the defect is enlarged or not closed sufficiently ( 4 ). This is also due to the anatomical situation, as the atrial walls tend to be stretched out and are difficult to contract.…”

Section: Discussionmentioning

confidence: 99%

Reduction of volume loss after left atrial injury by balloon occlusion—an experimental study

Irqsusi,

Dielmann,

Talipov

et al. 2023

J Thorac Dis

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Background Advanced-stage lung cancers sometimes require an extensive surgical approach. There is a risk of severe bleeding due to injury to the cardiac atria. Due to the fact that in most cases the surgical planning does not involve the expertise of a heart surgeon or the availability of a heart lung machine, only rapid effective action can avert this life-threatening complication. Methods In an experimental study of porcine heart-lung packs, three different methods were used to investigate the most effective way of controlling mass hemorrhage due to left atrial injury. In order to obtain a realistic model, the heart-lung packet was connected to a heart-lung machine after appropriate preparation and perfused with volume support. The damage control to the left atrial injury was either performed by manual compression, surgical clamping or balloon catheter occlusion. Results In addition to manual compression and clamping, the use of a balloon catheter inserted into the atrial lesion was found to be the most effective method. The blood loss of 41.88±7.53 mL ( vs. 105.00±31.74 and 106.00±50.67 mL) proved to be the lowest value. Conclusions For extensive resections of lung carcinoma, balloon catheters of different sizes should be kept ready to rapidly control massive blood loss due to injury of the cardiac atria.

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Thoraxletsels bij kinderen

Leenen¹,

Kramer²

2019

Kindertraumachirurgie

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Intraoperative Blutungen in der Thoraxchirurgie

Cited by 4 publications

References 13 publications

Effects of Body Position and Hypovolemia on the Regional Distribution of Pulmonary Perfusion During One-Lung Ventilation in Endotoxemic Pigs

Effects of Body Position and Hypovolemia on the Regional Distribution of Pulmonary Perfusion During One-Lung Ventilation in Endotoxemic Pigs

Reduction of volume loss after left atrial injury by balloon occlusion—an experimental study

Thoraxletsels bij kinderen

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