title: Abdominal insufflation decreases blood loss and mortality after porcine liver injury.
abstract: BACKGROUND
  Uncontrolled intra-abdominal bleeding is a common cause of death in trauma patients in the prehospital and perioperative settings. The detrimental effects of abdominal hypertension are well studied, but the potential therapeutic use of abdominal insufflation for hemostasis has not been fully explored. We measured the effect of abdominal insufflation on blood loss and physiologic outcomes in a swine model of blunt liver injury.
  
  
  METHODS
  Twenty-one anticoagulated swine (32 +/- 3 kg) were anesthesized; laparotomy was performed to localize liver anatomy and to place loose tourniquettes isolating the porta hepatis and supra/infrahepatic vena cava. A captive bolt gun was used to create a grade V hepatic laceration, producing massive parenchymal injury as well as complex tears of the middle and right hepatic veins. Animals were randomized into either control (n = 10) or abdominal insufflation at 20 cm H(2)O pressure (n = 11) groups. Crystalloid was used to maintain a mean arterial pressure of 30 mm Hg. Arterial pressure and other physiologic variables were recorded for 20 minutes. Animals were then sacrificed and blood loss measured.
  
  
  RESULTS
  Blood loss was 69% lower in insufflated animals compared with controls (384 +/- 51 versus 1252 +/- 88 cc, p < 0.001). After 20 minutes, insufflated animals had significantly higher mean arterial blood pressure (32.2 +/- 4.2 versus 21.2 +/- 4.0 mm Hg) and lower total resuscitation volume (195 +/- 83 versus 1356 +/- 95 cc). Three pigs died in the control group (30%), whereas no insufflated animals died (p < 0.05).
  
  
  CONCLUSIONS
  In a swine model of catastrophic blunt hepatic injury, abdominal insufflation significantly decreased blood loss and mortality.
authors.affiliation: Division of Trauma, Washington Hospital Center, Washington, D.C. 20010, USA.
authors.forename: Amín
authors.initials: A
authors.lastname: Jaskille
authors.forename: Adam
authors.initials: A
authors.lastname: Schechner
authors.forename: Ken
authors.initials: K
authors.lastname: Park
authors.forename: Michael
authors.initials: M
authors.lastname: Williams
authors.forename: Dennis
authors.initials: D
authors.lastname: Wang
authors.forename: Jack
authors.initials: J
authors.lastname: Sava
mesh_terms: D000005:Abdomen; D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume; D004195:Disease Models, Animal; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D006339:Heart Rate / Q000502:physiology; D007327:Insufflation / Q000379:methods*; D008099:Liver / Q000293:injuries*; D013552:Swine; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000503:physiopathology