title: The effects of early rapid control of multiple bowel perforations after high-energy trauma to the abdomen: implications for damage control surgery.
abstract: BACKGROUND
  This study evaluates the effects of early rapid control of multiple bowel perforations on cardiovascular and pulmonary function in high-energy traumatic shock compared with conventional small bowel resection anastomosis.
  
  
  METHODS
  Fifteen anesthetized pigs, 10 to 12 weeks old, were exposed to a reproducible high-energy trauma and were divided into two groups. In the first group, the resection anastomosis group (RA, n = 8), small-bowel injuries were treated with resection and anastomosis; in the second group, the multiple bowel ligation group (BL, n = 7), small-bowel injuries were treated by resection and ligation. Repeated measurement analysis of variance was used to study the within group change overtime, the between group difference, and the interaction between them. Mean outcome measures were intravascular pressures, cardiac output, vascular resistance, lactic acid, and blood gases.
  
  
  RESULTS
  The high-energy injuries caused traumatic shock in both groups with reduced cardiac output (p < 0.001) and lactic acidemia (p < 0.001). The BL group had a trend for higher cardiac output (p = 0.06). The rise in systemic and pulmonary vascular resistance was significantly reduced in the BL group compared with the RA group (p < 0.05). The BL group had a strong trend for higher oxygen extraction ratio (p = 0.06). There was a trend for less oxygen consumption in the BL group (p = 0.07). There was no difference in the lactic acidemia between the two groups.
  
  
  CONCLUSIONS
  Early rapid control of multiple bowel perforations after high-energy trauma resulted in less impairment of cardiovascular function than conventional resection anastomosis of the bowel.
authors.affiliation: Centre for Teaching and Research in Disaster Medicine and Traumatology, University of Linköping, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Olofsson
authors.forename: Fikri M
authors.initials: FM
authors.lastname: Abu-Zidan
authors.forename: Jianpu
authors.initials: J
authors.lastname: Wang
authors.forename: Nico
authors.initials: N
authors.lastname: Nagelkerke
authors.forename: Sten
authors.initials: S
authors.lastname: Lennquist
authors.forename: Thore
authors.initials: T
authors.lastname: Wikstrom
mesh_terms: D000140:Acidosis, Lactic; D000714:Anastomosis, Surgical; D000818:Animals; D002302:Cardiac Output; D007416:Intestinal Perforation / Q000150:complications / Q000601:surgery*; D009104:Multiple Trauma / Q000150:complications / Q000601:surgery*; D012774:Shock, Traumatic / Q000209:etiology / Q000601:surgery; D013552:Swine; D014655:Vascular Resistance; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery*