title: Percutaneous aspiration of fluid for management of peritonitis in space.
abstract: BACKGROUND
  As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy.
  
  
  OBJECTIVE
  Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity.
  
  
  METHODS
  Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid.
  
  
  RESULTS
  Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals.
  
  
  CONCLUSIONS
  Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.
authors.affiliation: Vancouver General Hospital, British Columbia, Canada. andrew.kirkpatrick@calgaryhealthregion.ca
authors.forename: A W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.forename: S
authors.initials: S
authors.lastname: Nicolaou
authors.forename: M R
authors.initials: MR
authors.lastname: Campbell
authors.forename: A E
authors.initials: AE
authors.lastname: Sargsyan
authors.forename: S A
authors.initials: SA
authors.lastname: Dulchavsky
authors.forename: S
authors.initials: S
authors.lastname: Melton
authors.forename: G
authors.initials: G
authors.lastname: Beck
authors.forename: D L
authors.initials: DL
authors.lastname: Dawson
authors.forename: R D
authors.initials: RD
authors.lastname: Billica
authors.forename: S L
authors.initials: SL
authors.lastname: Johnston
authors.forename: D R
authors.initials: DR
authors.lastname: Hamilton
mesh_terms: D000818:Animals; D004322:Drainage; D005240:Feasibility Studies; D005260:Female; D010538:Peritonitis / Q000601:surgery*; D013026:Space Flight; D013552:Swine; D014463:Ultrasonography; D014893:Weightlessness; D018474:Weightlessness Simulation