PURPOSE: Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury. METHOD: A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q₁, Q₃) as indicated. χ² or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance. RESULTS: Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention. CONCLUSION As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.
Humans ; Male ; Adult ; Female ; Wounds, Nonpenetrating/physiopathology* ; Spleen/injuries* ; Prospective Studies ; Cross-Sectional Studies ; Liver/injuries* ; Middle Aged ; Monitoring, Physiologic/methods* ; Pressure ; Abdominal Injuries/physiopathology* ; Intra-Abdominal Hypertension ; Young Adult

OBJECTIVETo investigate the effects of CO(2) pneumoperitoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock model and liver impact injuries.

METHODSAfter controlled hemorrhagic shock and liver impact injuries, the rabbit model was established. Eighteen rabbits subjected to hemorrhagic shock and liver impact injuries were divided into 3 groups randomly according to the volume of lost blood: light hemorrhagic shock (blood loss volume was 10%, 6 ml/kg), moderate hemorrhagic shock (20%, 12 ml/kg) and severe hemorrhagic shock (40%, 22 ml/kg). Intraabdominal pressures of CO(2) pneumoperitoneum was 10 mmHg. Color-labeled microspheres were used to measure the blood flow volume of the liver, kidney and stomach before pneumoperitoneum at 30 minutes and 2 hours after pneumoperitoneum and 30 minutes after deflation. And the mortality and hepatic traumatic condition of rabbits were recorded.

RESULTSOf the 18 rabbits, there were 9 with liver impact injuries at Grade I , 8 at Grade II and 1 at Grade III (according to AIS-2005). The mortality rate in light hemorrhagic shock group was 33.33%, and that in moderate or severe hemorrhagic shock group was 100% within 30 minutes and 2 hours after pneumoperitoneum, respectively. The blood flow volume in the organs detected decreased at 30 minutes under pneumoperitoneum in light and moderate hemorrhagic shock groups. At the same time, the blood flow volume of the liver in moderate hemorrhagic shock group decreased more significantly than that in light hemorrhagic shock group.

CONCLUSIONSThe blood flow volume of abdominal organs in rabbits is decreased obviously under CO(2) pneumoperitoneum, with fairly high mortality rate. It is believed that CO(2) pneumoperitoneum should cautiously be used in abdominal injury accompanied with hemorrhagic shock, especially under non-resuscitation conditions.

Abdominal Injuries ; diagnosis ; Animals ; Blood Volume ; Carbon Dioxide ; Female ; Liver ; injuries ; Male ; Pneumoperitoneum, Artificial ; Rabbits ; Regional Blood Flow ; Shock, Hemorrhagic ; physiopathology

OBJECTIVETo study the change of motor evoked potential of the diaphragm after graded upper cervical cord injuries and analyze the prognosis of the respiratory function after upper cervical cord injuries by MEP.

METHODSThe C(3, 4) spinal cord of 40 SD rats were injured with modified Allen method by weight drop force of 30 gcf, 50 gcf, 80 gcf, 100 gcf. The change of latent and amplitude of MEP of the diaphragm was observed before and after the spinal cord injuries (followed up for 1 month). At the same time, the femoral arterial blood of 0.2 ml was drawn. The pH value, the partial pressure of oxygen, the partial pressure of carbon dioxide, and the saturation of the blood oxygen were monitored. The change of the respiratory function was evaluated in the rats after cervical cord injuries. The relationship between the recovery of the respiratory function and the latent or amplitude was analyzed.

RESULTSThe MEP wave of the diaphragm was stable before the upper cervical spinal cord injury in the rats. It was usually composed of a positive and negative wave. The latent period and peak-peak amplitude of wave were (3.13 +/- 0.29) ms and (6.78 +/- 3.48) mv. The latent period of the diaphragms MEP in rats change with graded upper cervical cord injuries significantly, the more sever the injury, the longer the latent period. There were obvious relationship between the change of the latent period and the recovery of the respiratory function. When the latent period prolonged 101%, the respiratory function is hardly to recovery.

CONCLUSIONSMEP can objectively and sensitively reflect the injury extent of the respiratory function when upper cervical cord is injured. It would be a reliable index to evaluate the long-term prognosis of respiratory function.

Abdominal Muscles ; physiopathology ; Animals ; Blood Gas Analysis ; Cervical Vertebrae ; Disease Models, Animal ; Evoked Potentials, Motor ; physiology ; Male ; Prognosis ; Rats ; Rats, Sprague-Dawley ; Respiration ; Spinal Cord Injuries ; blood ; diagnosis ; physiopathology