Abstract
Tissue perfusion during surgery is important in reducing surgical site infections and promoting healing. This study aimed to determine if insufflation of the open abdomen with heated, humidified (HH) carbon dioxide (CO2) increased visceral tissue perfusion and core body temperature during open abdominal surgery in a rodent model. Using two different rodent models of open abdominal surgery, visceral perfusion and core temperature were measured. Visceral perfusion was investigated using a repeated measures crossover experiment with rodents receiving the same sequence of two alternating treatments: exposure to ambient air (no insufflation) and insufflation with HH CO2. Core body temperature was measured using an independent experimental design with three treatment groups: ambient air, HH CO2 and cold, dry (CD) CO2. Visceral perfusion was measured by laser speckle contrast analysis (LASCA) and core body temperature was measured with a rectal thermometer. Insufflation with HH CO2 into a rodent open abdominal cavity significantly increased visceral tissue perfusion (2.4 perfusion units (PU)/min (95% CI 1.23–3.58); p<0.0001) compared with ambient air, which significantly reduced visceral blood flow (-5.20 PU/min (95% CI -6.83- -3.58); p<0.0001). Insufflation of HH CO2 into the open abdominal cavity significantly increased core body temperature (+1.15 ± 0.14°C) compared with open cavities exposed to ambient air (-0.65 ± 0.52°C; p = 0.037), or cavities insufflated with CD CO2 (-0.73 ± 0.33°C; p = 0.006). Abdominal visceral temperatures also increased with HH CO2 insufflation compared with ambient air or CD CO2, as shown by infrared thermography. This study reports for the first time the use of LASCA to measure visceral perfusion in open abdominal surgery and shows that insufflation of open abdominal cavities with HH CO2 significantly increases visceral tissue perfusion and core body temperature.
Highlights
The ability to perfuse sufficient oxygenated blood into a surgical wound plays a pivotal role in postoperative tissue recovery
Viscera temperatures appeared cooler in the CD CO2 group (Fig 2G), and an even cooler visceral temperature was observed in the ambient air group after 60 minutes (Fig 2F)
Subsequent human trials have shown that heating and humidifying CO2 can significantly ameliorate the damages induced by CD CO2 as well as prevent hypothermia frequently seen in laparoscopic procedures [35,36,37,38,39,40]
Summary
The ability to perfuse sufficient oxygenated blood into a surgical wound plays a pivotal role in postoperative tissue recovery. Two postoperative complications that can arise from poor tissue oxygenation (PtO2) during surgery are surgical site infections (SSI) and anastomotic leaks. SSI’s account for up to 20% of all hospital acquired infections and affect approximately 5% of surgical patients, with rates approaching 20% in colorectal surgery [3]. These nosocomial infections impact the recovery time of the patient and significantly increase the economic burden on health care systems, with 2–3 fold increases in patient care costs reported [4]. While advances in surgery have reduced the incidences of these postoperative complications the rates and costs on both the patient and healthcare system remain high
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