| 1. |
- Mokhtari, Arash, et al.
(författare)
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Haemodynamic effects of -75 mmHg negative pressure therapy in a porcine sternotomy wound model.
- 2009
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Ingår i: International Wound Journal. - 1742-481X. ; 6:1, s. 48-54
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Tidskriftsartikel (refereegranskat)abstract
- Previous research has shown -125 mmHg to be the optimal negative pressure for creating an environment that promotes wound healing, and this has therefore been adopted as a standard pressure for patients with deep sternal wound infection. However, it has not yet been clearly shown that -125 mmHg is the optimal pressure from a haemodynamic point of view. Furthermore, there have been reports of cardiac rupture during -125 mmHg negative pressure therapy. We therefore studied the effects of a lower pressure: -75 mmHg. Twelve pigs were used. After median sternotomy, sealed negative pressure therapy of -75 mmHg was applied. Baseline measurements were made and continuous recording of the cardiac output, end-tidal CO(2) production, mean arterial pressure, mean pulmonary pressure (pulmonary artery pressure), systemic vascular resistance, pulmonary vascular resistance, left atrial pressure and central venous pressure was started. Six pigs served as controls. No statistically significant difference was observed in any of the haemodynamic parameters studied, compared with the controls. The present study shows that, with a suitable foam application technique, -75 mmHg can be applied without compromising the central haemodynamics.
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| 2. |
- Sjögren, Johan, et al.
(författare)
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Negative-pressure wound therapy following cardiac surgery: bleeding complications and 30-days mortality in 176 patients with deep sternal wound infection.
- 2011
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 12:2, s. 117-120
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Tidskriftsartikel (refereegranskat)abstract
- Negative-pressure wound therapy (NPWT) has been used for the treatment of deep sternal wound infection (DSWI) with promising results. However, questions have been raised regarding the potential risk of right ventricle (RV) rupture during treatment. In the present study, we evaluate our clinical experience of NPWT focusing on RV rupture and major bleeding complications and its potentially negative impact on 30-day mortality during an 11-year period. Serious bleeding complications during NPWT were reviewed for 176 patients treated for DSWI between January 1999 and April 2010. The 30-day mortality following DSWI was 1.1% (2/176). Four patients (2.3%) suffered bleeding from the RV rupture during NPWT of the sternal wound (two spontaneous and two debridement related). Furthermore, two patients had debridement-related bleedings from the venous bypass grafts during wound dressing change. The very low 30-day mortality (1.1%) following DSWI supports the use of NPWT. Overall, even if major bleeding complications may occur, the risk of RV rupture seems to be outweighed by the benefit of superior infection control. However, surgical experience is recommended when debriding sternal wounds and we recommend the use of a wound dressing, such as paraffin gauze, in order to protect the RV from direct contact with the polyurethane foam. Keywords: Wound infection; Sternum; Negative-pressure wound therapy; Outcome.
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| 3. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Comparative outcome of double lung transplantation using conventional donor lungs and non-acceptable donor lungs reconditioned ex vivo.
- 2010
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293.
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Tidskriftsartikel (refereegranskat)abstract
- A method to evaluate and recondition lungs ex vivo has been tested on donor lungs that have been rejected for transplantation. In the present paper, we compare early postoperative course between the six patients who received reconditioned lungs and the patients who received conventional donor lungs during the same period of time. During 2006 and 2007, a total of 21 patients underwent double sequential lung transplantation at the University Hospital of Lund. Six of those patients received reconditioned lungs. The other 15 patients received conventional donor lungs for transplantation without reconditioning ex vivo. The results are presented as median and interquartile range. Time in intensive care unit (days) between recipients of reconditioned lungs [13 (5-24) days], and recipients of conventional donor lungs [7 (5-12) days], P=0.44. Total hospital stay after transplantation (days) between recipients of reconditioned lungs [52 (47-60) days] and recipients of conventional donor lungs [44 (37-48) days], P=0.9. Ex vivo lung evaluation and reconditioning might not prolong early postoperative course in double lung transplantation. However, given the small number of patients, there might be a failure to detect a difference between the two groups. Keywords: Double lung transplantation; Reconditioned lungs; Clinical outcome.
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| 4. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Impact of different topical negative pressure levels on myocardial microvascular blood flow.
- 2008
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Ingår i: Cardiovascular Revascularization Medicine. - : Elsevier BV. - 1878-0938 .- 1553-8389. ; 9:1, s. 29-35
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We have previously shown that a myocardial topical negative pressure (TNP) of -50 mmHg significantly increases microvascular blood flow in the underlying myocardium in normal, ischemic, and reperfused porcine myocardium. The present study was designed to elucidate the effect of different TNP levels between -50 and -150 mmHg on microvascular flow in normal and ischemic myocardium. MATERIALS AND METHODS: Seven pigs underwent median sternotomy. The microvascular blood flow in the myocardium was recorded, before and after the application of TNP, using laser Doppler velocimetry. Analyses were performed before left anterior descending artery (LAD) occlusion (normal myocardium) and after 20 min of LAD occlusion (ischemic myocardium). RESULTS: A TNP of -50 mmHg significantly increased microvascular blood flow in both normal (from 320.0+/-56.1 PU before TNP application to 435.7+/-65.5 PU after TNP application, P=.028) and ischemic myocardium (from 110.0+/-36.7 PU before TNP application to 194.3+/-56.2 PU after TNP application, P=.012). TNP between -75 and -150 mmHg showed no significant increase in microvascular blood flow in normal or ischemic myocardium. CONCLUSIONS: Of pressures between -50 and -150 mmHg, a TNP of -50 mmHg seems to be the most effective negative pressure concerning significant increase in microvascular blood flow in both normal and ischemic myocardium.
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| 5. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Macroscopic changes during negative pressure wound therapy of the open abdomen using conventional negative pressure wound therapy and NPWT with a protective disc over the intestines
- 2011
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Ingår i: BMC Surgery. - : Springer Science and Business Media LLC. - 1471-2482. ; 11, s. 10-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) than with other wound management techniques. However, the method has occasionally been associated with increased development of fistulae. We have previously shown that NPWT induces ischemia in the underlying small intestines close to the vacuum source, and that a protective disc placed between the intestines and the vacuum source prevents the induction of ischemia. In the present study we compare macroscopic changes after 12, 24, and 48 hours, using conventional NPWT and NPWT with a protective disc between the intestines and the vacuum source. Methods: Twelve pigs underwent midline incision. Six animals underwent conventional NPWT, while the other six pigs underwent NPWT with a protective disc inserted between the intestines and the vacuum source. Macroscopic changes were photographed and quantified after 12, 24, and 48 hours of NPWT. Results: The surface of the small intestines was red and mottled as a result of petechial bleeding in the intestinal wall in all cases. After 12, 24 and 48 hours of NPWT, the area of petechial bleeding was significantly larger when using conventional NPWT than when using NPWT with the protective disc (9.7 +/- 1.0 cm(2) vs. 1.8 +/- 0.2 cm(2), p < 0.001, 12 hours), (14.5 +/- 0.9 cm(2) vs. 2.0 +/- 0.2 cm(2), 24 hours) (17.0 +/- 0.7 cm(2) vs. 2.5 +/- 0.2 cm(2) with the disc, p < 0.001, 48 hours) Conclusions: The areas of petechial bleeding in the small intestinal wall were significantly larger following conventional NPWT after 12, 24 and 48 hours, than using NPWT with a protective disc between the intestines and the vacuum source. The protective disc protects the intestines, reducing the amount of petechial bleeding.
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| 6. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Microvascular Blood Flow Changes in the Small Intestinal Wall During Conventional Negative Pressure Wound Therapy and Negative Pressure Wound Therapy Using a Protective Disc Over the Intestines in Laparostomy.
- 2012
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Ingår i: Annals of Surgery. - 1528-1140 .- 0003-4932. ; 255, s. 171-175
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:: Blood flow changes in the intestines during conventional negative pressure wound therapy (NPWT), and NPWT using a protective disc over the intestines in laparostomy. BACKGROUND:: Higher closure rates of the open abdomen have been reported with NPWT compared with other kinds of wound management. However, the method has been associated with increased development of fistulae. We have compared the changes in blood flow in the intestinal wall using conventional NPWT and NWPT with a protective disc between the intestines and the vacuum source. METHODS:: Midline incisions were made in 10 pigs and either conventional NPWT or NPWT with a disc over the intestines was applied. The microvascular blood flow was measured in the intestinal wall before and after the application of topical negative pressures of -50, -70, and -120 mmHg, using laser Doppler velocimetry. RESULTS:: The blood flow was significantly decreased (by 24%) after the application of conventional NPWT at -50 mmHg, compared with a slight decrease (2%) after the application of NWPT with a protective disc (P < 0.05). The blood flow was significantly decreased (by 54%) after the application of conventional NPWT at -120 mmHg, compared with a slight decrease (17%) after application of NPWT using a protective disc (P < 0.001). CONCLUSIONS:: Inserting a disc between the intestines and the vacuum source in NPWT protects the intestines from ischemia. The decreased blood flow in the intestinal wall may induce ischemia, which could promote the development of intestinal fistulae.
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| 7. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Pressure transduction and fluid evacuation during conventional negative pressure wound therapy of the open abdomen and NPWT using a protective disc over the intestines
- 2012
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Ingår i: BMC Surgery. - : Springer Science and Business Media LLC. - 1471-2482. ; 12, s. 4-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Negative pressure wound therapy (NPWT) has gained acceptance among surgeons, for the treatment of open abdomen, since very high closure rates have been reported with this method, compared to other kinds of wound management for the open abdomen. However, the method has occasionally been associated with increased development of fistulae. We have previously shown that NPWT induces ischemia in the underlying small intestines close to the vacuum source, and that a protective disc placed between the intestines and the vacuum source prevents the induction of ischemia. In this study we compare pressure transduction and fluid evacuation of the open abdomen with conventional NPWT and NPWT with a protective disc. Methods: Six pigs underwent midline incision and the application of conventional NPWT and NPWT with a protective disc between the intestines and the vacuum source. The pressure transduction was measured centrally beneath the dressing, and at the anterior abdominal wall, before and after the application of topical negative pressures of -50, -70 and -120 mmHg. The drainage of fluid from the abdomen was measured, with and without the protective disc. Results: Abdominal drainage was significantly better (p < 0. 001) using NPWT with the protective disc at -120 mmHg (439 +/- 25 ml vs. 239 +/- 31 ml), at -70 mmHg (341 +/- 27 ml vs. 166 +/- 9 ml) and at -50 mmHg (350 +/- 50 ml vs. 151 +/- 21 ml) than with conventional NPWT. The pressure transduction was more even at all pressure levels using NPWT with the protective disc than with conventional NPWT. Conclusions: The drainage of the open abdomen was significantly more effective when using NWPT with the protective disc than with conventional NWPT. This is believed to be due to the more even and effective pressure transduction in the open abdomen using a protective disc in combination with NPWT.
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| 8. |
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| 9. |
- Mokhtari, Arash, et al.
(författare)
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The cost of vacuum-assisted closure therapy in treatment of deep sternal wound infection.
- 2008
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 42:1, s. 85-89
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Surgical sites infections are very expensive and the total costs for coronary artery bypass grafting (CABG) surgery followed by deep sternal wound infection (DSWI) with conventional therapy are estimated to be 2.8 times that for normal, CABG surgery. Promising results have been reported with vacuum-assisted closure (VAC) therapy in patients with DSWI. This study presents the cost of VAC therapy in patients with DSWI after CABG surgery. Design. Thirty-eight CABG patients with DSWI, between 2001 and 2005, were treated with VAC therapy. The cost of surgery, intensive care, ward care, laboratory tests and other costs were analyzed. Results. No three-month mortality or recurrent infection was observed. The average cost of CABG procedure and treatment of DSWI was 2.5 times higher than the mean cost of CABG alone. No significant correlations were found between the preoperative EuroSCORE and the cost of DSWI therapy. Conclusions. VAC therapy for patients who underwent CABG surgery followed by DSWI seems to be cost effective, and has low mortality rate.
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| 10. |
- Sjögren, Johan, et al.
(författare)
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Clinical outcome after poststernotomy mediastinitis: Vacuum-assisted closure versus conventional treatment
- 2005
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 79:6, s. 2049-2055
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Tidskriftsartikel (refereegranskat)abstract
- Background. The conventional treatment for poststernotomy mediastinitis usually involves surgical revision, closed irrigation, or reconstruction with omentum or pectoral muscle flaps. Recently, vacuum-assisted closure has been successfully used in poststernotomy mediastinitis. The aim of the present study was to compare the clinical outcome and survival in 101 patients undergoing vacuum-assisted closure therapy or conventional treatment for poststernotomy mediastinitis. Methods. One hundred one consecutive patients underwent treatment for poststernotomy mediastinitis: vacuum-assisted closure therapy (January 1999 through December 2003, n = 61) or conventional treatment (July 1994 through December 1998, n = 40). Follow-up was made in April 2004 and was 100% complete. Actuarial statistics were used to calculate the survival rates. Results. The 90-days mortality was 0% in the vacuum-assisted closure group and 15% in the conventional treatment group (p < 0.01). The failure rate to first-line treatment with vacuum-assisted closure and conventional treatment were 0% and 37.5%, respectively (p < 0.001). There was no statistically significant difference in the recurrence of sternal fistulas after vacuum-assisted closure therapy or conventional treatment: 6.6% versus 5.0%, respectively. Overall survival in the vacuum-assisted closure group was significantly better (p < 0.05) than in the conventional treatment group: 97% versus 84% (6 months), 93% versus 82% (1 year), and 83% versus 59% (5 years). Conclusions. Our findings support that vacuum-assisted closure therapy is a safe and reliable option in poststernotomy mediastinitis with excellent survival and a very low failure rate compared with conventional treatment.
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| 11. |
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| 12. |
- Sjögren, Johan, et al.
(författare)
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Vacuum-assisted closure therapy for deep sternal wound infections: the impact of learning curve on survival and predictors for late mortality.
- 2008
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Ingår i: International Wound Journal. - 1742-481X. ; 5:2, s. 216-223
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the possible learning curve effects on survival during the introduction of vacuum-assisted closure (VAC) therapy in patients with deep sternal wound infection (DSWI). Furthermore, predictors of late mortality were analysed and causes of late death were examined. Fifty-three patients (early Group, n = 26, January 1999 to July 2001 versus late group, n = 27, August 2001 to March 2003) were all treated with VAC for DSWI. A follow-up was carried out in September 2006. Multivariate analyses were used to evaluate the predictors of late mortality. The 90-day mortality was 0% in both groups. The survival rates at 5 years were 69.2 +/- 9.1% (early group) versus 58.5 +/- 11.7% (late group), P = ns (non significant). The time interval from cardiac surgery to diagnosis of DSWI and prolonged VAC therapy were identified as independent predictors of late mortality. Our concept for VAC therapy in DSWI seems to be readily introduced in clinical practice. There was no difference in survival between our initial cases and later cases. Late diagnosis and prolonged wound therapy were identified as predictors for late mortality.
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| 13. |
- Sjögren, Johan, et al.
(författare)
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Vakuumassisterad sår- behandling ger goda kliniska resultat God läkning vid komplicerade sår--djupa sternuminfektioner ett exempel.
- 2008
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Ingår i: Läkartidningen. - 0023-7205. ; 105:40, s. 2773-2776
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Tidskriftsartikel (refereegranskat)abstract
- acuum-assisted closure (V.A.C.®) is a novel treatment for wound healing, which has been used extensively during the last years in a growing number of clinical applications. This wound-healing technique is based on the application of local negative pressure to a wound. During treatment with vacuum-assisted closure, several beneficial wound healing mechanisms are initiated. Topical negative pressure increases the microvascular blood flow in the surrounding tissue and reduces wound tissue oedema and wound size. Furthermore, the stimulation of growth factors and neoangiogenesis facilitates the formation of granulation tissue in the wound. Vacuum-assisted closure has been widely adopted as a standard treatment for deep sternal wound infections following cardiac surgery since topical negative pressure combines several advantageous features from conventional surgical techniques. However, although it is effective, vacuum-assisted closure must always be used in combination with proper surgical revision and adequate antibiotic therapy in order to obtain optimal results.
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| 14. |
- Acosta, Stefan, et al.
(författare)
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Engaging patients and caregivers in establishing research priorities for aortic dissection
- 2019
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Ingår i: SAGE Open Medicine. - : Sage Publications. - 2050-3121. ; 7, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to establish the top 10 research uncertainties in aortic dissection together with the patient organization Aortic Dissection Association Scandinavia using the James Lind Alliance concept. Methods: A pilot survey aiming to identify uncertainties sent to 12 patients was found to have high content validity (scale content validity index = 0.91). An online version of the survey was thereafter sent to 30 patients in Aortic Dissection Association Scandinavia and 45 caregivers in the field of aortic dissection. Research uncertainties of aortic dissection were gathered, collated and processed. Results: Together with research priorities retrieved from five different current guidelines, 94 uncertainties were expressed. A shortlist of 24 uncertainties remained after processing for the final workshop. After the priority-setting process, using facilitated group format technique, the ranked final top 10 research uncertainties included diagnostic tests for aortic dissection; patient information and care continuity; quality of life; endovascular and medical treatment; surgical complications; rehabilitation; psychological consequences; self-care; and how to improve prognosis. Conclusion: These ranked top 10 important research priorities may be used to justify specific research in aortic dissection and to inform healthcare research funding decisions.
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| 15. |
- El-Segaier, Milad, et al.
(författare)
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Atrial septal defect: a diagnostic approach
- 2006
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Ingår i: Medical & Biological Engineering & Computing. - : Springer Science and Business Media LLC. - 0140-0118 .- 1741-0444. ; 44:9, s. 739-745
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Tidskriftsartikel (refereegranskat)
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| 16. |
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| 17. |
- Fleck, Tatjana, et al.
(författare)
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The management of deep sternal wound infections using vacuum assisted closure (V.A.C.) therapy
- 2006
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Ingår i: International Wound Journal. - 1742-481X. ; 3:4, s. 273-280
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Tidskriftsartikel (refereegranskat)abstract
- A group of international experts met in May 2006 to develop clinical guidelines on the practical application of vacuum assisted closure (V.A.C.)+ therapy in deep sternal wound infections. Group discussion and an anonymous interactive voting system were used to develop content. The recommendations are based on current evidence or, where this was not available, the majority consensus of the international group. The principles of treatment for deep sternal wound infections include early recognition and treatment of infection. V.A.C. therapy should be instigated early, following thorough wound irrigation and surgical debridement. V.A.C. therapy in deep sternal wound infections requires specialist surgical supervision and should only be undertaken by clinicians with adequate experience and training in the use of the technique.
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| 18. |
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| 19. |
- Gustafsson, Ronny, et al.
(författare)
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Invited commentary.
- 2011
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 91:5, s. 1589-1590
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Tidskriftsartikel (refereegranskat)
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| 20. |
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| 21. |
- Gyllensvärd, Johan, et al.
(författare)
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C-reactive protein- and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative.
- 2020
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Ingår i: BMC pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Early-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. In the study we evaluated if a quality improvement initiative could reduce unwarranted antibiotic use in a safe way in term neonates with culture-negative sepsis.The quality improvement initiative included new treatment guidelines and were introduced on 11 June 2018. The guidelines included C-reactive protein- and clinical symptoms-guided decision-making and shorter intravenous antibiotic therapy. All term neonates treated for EOS at Ryhov Hospital, Jönköping, Sweden were studied before (period 1: 2016-2017) and after the introduction of the new guidelines (period 2: 11 June 2018 to 30 Sept 2019). Laboratory and clinical data were analysed.There were 7618 term neonates in period 1 and 5005 term neonates in period 2. We identified 140 (1.8%) EOS in period 1 and 97 (1.9%) EOS in period 2. During period 1 and 2, there were 61 (61/140, 44%) and 59 (59/97, 61%) EOS neonates, respectively, who met the criteria for shorter antibiotic treatment. The number of positive blood cultures were seven (0.92/1000 live births) and five (1.0/1000 live births) in period 1 and 2. The median C-reactive protein were 52mg/L (37-62) in period 1 and 42mg/L (31-56) in period 2 in the group who met the criteria of the guidelines. The duration of antibiotic therapy (Median: seven vs. five days, p<0.001) and hospital stay (Median: seven vs. five days, p<0.001) as well as healthcare costs (decreased by €122,000/year) was reduced in the group who met the criteria after the introduction of the guidelines.C-reactive protein- and clinical symptoms-guided decision-making for EOS significantly decreased the duration of antibiotic therapy and hospital stay, and hence reduced healthcare costs, with no reinfection in a cohort of term infants.Trial registration number: ISRCTN29535824 . Date of registration: 28 May 2020. Retrospectively registered.
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| 22. |
- Hlebowicz, Joanna, et al.
(författare)
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Microvascular blood flow response in the intestinal wall and the omentum during negative wound pressure therapy of the open abdomen
- 2012
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 27:3, s. 397-403
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Tidskriftsartikel (refereegranskat)abstract
- Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) compared with other wound therapy techniques. However, the method has occasionally been associated with increased development of intestinal fistulae. The present study measures microvascular blood flow in the intestinal wall and the omentum before and during NPWT. Six pigs underwent midline incision and application of NPWT to the open abdomen. The microvascular blood flow in the underlying intestinal loop wall and the omentum was recorded before and after the application of NPWT of -50, -70, -100, -120, -150, and -170 mmHg respectively, using laser Doppler velocimetry. A significant decrease in microvascular blood flow was seen in the intestinal wall during application of all negative pressures levels. The blood flow was 2.7 (+/- 0.2) Perfusion Units (PU) before and 2.0 (+/- 0.2) PU (*p < 0.05) after application of -50 mmHg, and 3.6 (+/- 0.6) PU before and 1.5 (+/- 0.2) PU (**p < 0.01) after application of -170 mmHg. In the present study, we show that negative pressures between -50 and -170 mmHg induce a significant decrease in the microvascular blood flow in the intestinal wall. The decrease in blood flow increased with the amount of negative pressure applied. One can only speculate that a longstanding decreased blood flow in the intestinal wall may induce ischemia and secondary necrosis in the intestinal wall, which, theoretically, could promote the development of intestinal fistulae. We believe that NPWT of the open abdomen is a very effective treatment but could probably be improved.
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| 23. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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Comparative study of the microvascular blood flow in the intestinal wall during conventional negative pressure wound therapy and negative pressure wound therapy using paraffin gauze over the intestines in laparostomy
- 2012
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Ingår i: International Wound Journal. - 1742-4801 .- 1742-481X. ; 9:2, s. 150-155
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Tidskriftsartikel (refereegranskat)abstract
- Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) than with other kinds of wound management. We have recently shown that NPWT decreases the blood flow in the intestinal wall, and that the blood flow could be restored by inserting a protective disc over the intestines. The aim of the present study was to investigate whether layers of Jelonet (TM) (Smith & Nephew) dressing (paraffin tulle gras dressing made from open weave gauze) over the intestines could protect the intestines from hypoperfusion. Midline incisions were made in ten pigs and were subjected to treatment with NPWT with and without four layers of Jelonet over the intestines. The microvascular blood flow was measured in the intestinal wall before and after the application of topical negative pressures of -50, -70 and -120 mmHg, using laser Doppler velocimetry. Baseline blood flow was defined as 100% in all settings. The blood flow was significantly reduced, to 61 +/- 7% (P < 0.001), after the application of -50 mmHg using conventional NPWT, and to 62 +/- 7% (P < 0.001) after the application of -50 mmHg with Jelonet dressings between the dressing and the intestines. The blood flow was significantly reduced, to 38 +/- 5% (P < 0.001), after the application of -70 mmHg, and to 42 +/- 6% (P < 0.001) after the application of -70 mmHg with Jelonet dressings. The blood flow was significantly reduced, to 34 +/- 9% (P < 0.001), after the application of -120 mmHg, and to 38 +/- 6% (P < 0.001) after the application of -120 mmHg with Jelonet dressings. The use of four layers of Jelonet over the intestines during NPWT did not prevent a decrease in microvascular blood flow in the intestinal wall.
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| 24. |
- Lindstedt Ingemansson, Sandra, et al.
(författare)
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The effect of negative wound pressure therapy on haemodynamics in a laparostomy wound model
- 2013
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Ingår i: International Wound Journal. - 1742-4801 .- 1742-481X. ; 10:3, s. 285-290
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Tidskriftsartikel (refereegranskat)abstract
- We have recently shown that negative pressure wound therapy (NPWT) induces a decrease in microvascular blood flow in the small intestinal loop close to the dressing. The effect of NPWT is thus thought to be local. In this study, we investigate whether the application of NPWT in laparostomy affects the haemodynamics. Midline incisions were made in six pigs followed by NPWT at 120 mmHg for 20 minutes. The cardiac output, mean systemic arterial pressure, mean pulmonary artery pressu re, central venous pressure, left atrial pressure and superior mesenteric artery blood flow were recorded. The blood flow in a small branch of the superior mesenteric artery was then recorded under NPWT between 50 and 175 mmHg. Cardiac output was not affected by NPWT [P = not significant (n.s.)]. Neither the mean arterial pressure nor the mean pulmonary artery pressure was affected by NPWT (P = n.s.). Negative pressures of 50, 75, 100 and 125 mmHg did not alter the blood flow in the small branch of the superior mesenteric artery (P = n.s.). After application of 150 mmHg, a significant decrease in blood flow was seen (P < 0 center dot 01), while the application of 175 mmHg resulted in only a slight decrease in blood flow (P = n.s.). The effect of NPWT in laparotomy seems to be local and to have no influence on central haemodynamics or the blood flow to the superior mesenteric artery.
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| 25. |
- Malmsjö, Malin, et al.
(författare)
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Mechanisms governing the effects of vacuum-assisted closure in cardiac surgery
- 2007
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Ingår i: Plastic and Reconstructive Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052. ; 120:5, s. 1266-1275
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Tidskriftsartikel (refereegranskat)abstract
- Vacuum-assisted closure has been adopted as the first-line treatment for poststernotomy mediastinitis as a result of the excellent clinical outcome achieved with its use. Scientific evidence regarding the mechanisms by which vacuum-assisted closure promotes wound healing has started to emerge, although knowledge regarding the effects on heart and lung function is still limited. The organs in the mediastinum are hemodynamically crucial, and in patients with poststernotomy mediastinitis, vulnerable bypass grafts and reduced cardiac function must be taken into consideration during vacuum-assisted closure therapy. This article provides an overview of the effects of vacuum-assisted closure on heart and lung function and summarizes the current knowledge on the mechanisms by which vacuum-assisted closure therapy promotes wound healing.
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