Nyman Jesper, Svenarud Peter, van der Linden Jan
Division of Perioperative Medicine and Intensive Care, Section Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital Solna, SE-17176, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Cardiothorac Surg. 2019 Jan 17;14(1):12. doi: 10.1186/s13019-018-0824-4.
Arterial air embolism during open heart surgery may cause postoperative complications including cerebral injury, myocardial dysfunction, and dysrhythmias. Despite standard de-airing techniques during surgery large amounts of arterial air emboli may still occur, especially during weaning from cardiopulmonary bypass. To prevent this insufflation of carbon dioxide in the wound cavity has been used since the 1950s. The aim of this study was to assess a new mini-diffuser for efficient carbon dioxide de-airing of a minimal invasive cardiothoracic wound cavity model. Up until now no device has been evaluated for this purpose.
A new insufflation device, a mini-diffuser, was tested. A thin plastic tube was used as control. The end of the mini-diffuser or the control, respectively, was positioned in a minimal invasive thoracic wound model. Remaining air content was measured during steady state and during intermittent suction with a rough suction device at different carbon dioxide flow rates. Measurements were also carried out in the open surgical wound during minimal invasive aortic surgery in six patients.
The air content was below 1% 4 cm below the surface of the open wound model during continuous carbon dioxide inflow of 2-10 L/min with the mini diffuser. In comparison, carbon dioxide insufflation via the open-ended tube resulted in a mean air content between 10 and 75%. The mean air content of the wound model remained below 1% at a carbon dioxide flow rate of 3-5 L/min during intermittent application of a suction device with a suction rate of 15 L/min. In 6 patients undergoing minimal invasive aortic valve replacement air content in the open surgical wound remained below 1% at a continuous carbon dioxide flow rate of 5 and 8 L/min via the mini-diffuser, respectively.
The mini diffuser was effective for carbon dioxide de-airing, i.e. < 1% remaining air, of a minimal invasive cardiothoracic wound cavity model with and without intermittent rough suction as well as in patients undergoing minimal invasive aortic valve surgery.
心脏直视手术期间的动脉空气栓塞可能导致术后并发症，包括脑损伤、心肌功能障碍和心律失常。尽管手术中有标准的排气技术，但大量动脉空气栓子仍可能出现，尤其是在体外循环撤机期间。自20世纪50年代以来，伤口腔内注入二氧化碳已被用于预防这种情况。本研究的目的是评估一种新型微型扩散器，用于在微创心胸伤口腔模型中高效进行二氧化碳排气。到目前为止，尚未有设备为此目的进行评估。
测试了一种新型注入装置——微型扩散器。使用一根细塑料管作为对照。微型扩散器或对照的末端分别置于微创胸壁伤口模型中。在不同二氧化碳流速下，使用粗吸引装置在稳态和间歇吸引期间测量剩余空气含量。还在6例患者进行微创主动脉手术期间，在开放手术伤口中进行了测量。
使用微型扩散器以2 - 10升/分钟的流速持续注入二氧化碳时，开放伤口模型表面以下4厘米处的空气含量低于1%。相比之下，通过开口管注入二氧化碳导致平均空气含量在10%至75%之间。在以15升/分钟的吸引速率间歇应用吸引装置期间，当二氧化碳流速为3 - 5升/分钟时，伤口模型的平均空气含量保持在1%以下。在6例接受微创主动脉瓣置换术的患者中，通过微型扩散器分别以5升/分钟和8升/分钟的持续二氧化碳流速时，开放手术伤口中的空气含量保持在1%以下。
微型扩散器在有或没有间歇粗吸引的情况下，对于微创心胸伤口腔模型以及接受微创主动脉瓣手术的患者进行二氧化碳排气是有效的，即剩余空气<1%。
