A System for Simple Real-Time Anastomotic Failure Detection and Wireless Blood Flow Monitoring in the Lower Limbs

Introduction: Reliable non-invasive monitoring of cerebral blood flow (CBF) during cardiac arrest would greatly facilitate goal-directed brain resuscitation during CPR. The Ornim c-FLOW™ provides real-time, continuous, non-invasive, direct monitoring of CBF via ultrasound tagged near infrared spectroscopy using adhesive sensors applied to the forehead. Values range from 0-100 units with a reported baseline value of 55±7 units (mean±sd). C-FLOW™ values are refreshed every three seconds for each of two forehead probes. The feasibility of using c-FLOW™ to monitor CBF during cardiac arrest has not been previously reported. Methods: The c-FLOW™ was applied in the ED to adult patients undergoing CPR for cardiac arrest that occurred in the ED or outside the hospital. c-FLOW™ values were continuously recorded during CPR and for up to 6 hours post-ROSC. c-FLOW™ values were correlated with corresponding end-tidal CO 2 (PetCO 2 ) values during CPR. Changes in c-FLOW™ values after vasopressor therapy were also quantified. Results: c-FLOW™ values were continuously recorded on patients undergoing CPR during 10 cardiac arrests. Initial, minimum, maximum, and mean values during CPR were 30.7±12.7, 17.3±15.0, 51.3±15.6, and 31.3±12.6 units, respectively. Maximum values after ROSC and VA ECMO were 43.0±10.9 and 59.0±12.0 units, respectively, and mean values after ROSC and VA ECMO were 24.0±11.7 and 35.3±12.7 units, respectively. The minimum value recorded after cessation of resuscitation efforts was 1.7±3.7 units. There was no significant correlation between c-FLOW™ values and simultaneous PetCO 2 values during CPR (R 2 0.01, p>0.05). c-FLOW™ values increased 7.6±8.5 units after IV/IO epinephrine boluses during CPR, though increased less with each subsequent bolus. Conclusions: Application of the c-FLOW™, a continuous real-time monitor of CBF, during cardiac arrest is feasible in the ED setting. c-FLOW™ values suggest variable and dynamic CBF during CPR. c-FLOW™ values do not appear to correlate with PetCO 2 but appear to detect increases in CBF associated with vasopressor therapy during CPR. Future studies are needed to determine the value of continuous non-invasive CBF monitoring as part of a goal-directed strategy to optimize brain resuscitation during CPR.

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THE CAUSES OF INTESTINAL ANASTOMOTIC LEAKAGE IN EXPERIMENTAL PERITONITIS

Novosti Khirurgii ◽

10.18484/2305-0047.2021.2.137 ◽

2021 ◽

Vol 29 (2) ◽

pp. 137-145

Author(s):

K.D. Morozov ◽

◽

O.L. Morozova ◽

L.O. Severgina ◽

T.D. Marchuk ◽

...

Keyword(s):

Blood Flow ◽

Intestinal Anastomosis ◽

Abdominal Cavity ◽

Perioperative Period ◽

Mesenteric Blood Flow ◽

Anastomotic Failure ◽

Flow Monitoring ◽

White Rats ◽

Group 3 ◽

Group 1

Objective. To determine the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis. Methods. The experiment was carried out on non-linear white rats (n=40), divided into 4 equal groups: with peritonitis (group 1), with hypovolemia (group 2), with peritonitis in combination with hypovolemia (group 3) and comparison (group 4). Colonic “end-to-end” anastomosis was performed in all rats. Peritonitis caused by injection of 10% unfiltered feces into the abdominal cavity. Hypovolemia was modeled during the operation by creating bleeding from the branch of the iliocolic artery.The rats were taken out of the experiment on the 3<sup>rd</sup> day after the operation, the state of the anastomosis and the abdominal cavity was assessed. The histological examination of the anastomotic sites was performed. The content of hypoxia biomarkers (HIF-1a, VEGF-C, VEGF-R1) in the intestinal tissue was also evaluated by ELISA. The experiment was approved by the local ethics committee. Results. In group 1, anastomotic failure was detected in rats characterized by a severe general condition due to peritonitis. In groups 2 and 3 statistically significant relationship was found between a decrease of rectal temperature (>2 °C) due to bleeding and colonic anastomotic failure (p<0.05). Morphological analysis showed the most pronounced inflammatory and microcirculatory changes in the group 3. Statistically significant differences in the level of the VEGF-C (p=0.0034) and VEGF-R1 (p=0.04795) were found between groups. Maximal ischemia of the anastomotic zone was found in rats of group 3. Conclusion. The leading factor in the pathogenesis of intestinal anastomotic failure is considered to be as a result of impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow. Monitoring and successful correction of hemodynamic disturbances in the perioperative period may become a prospect for the treatment of patients with peritonitis requiring intestinal anastomosis under these conditions. What this paper adds For the first time determination of the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis has been studied. The leading factor in the pathogenesis of intestinal anastomotic failure has been found out to be the impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow.

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