Intraoperative CO(2) insufflation can decrease the risk of surgical site infection
Surgical wound infections may ruin otherwise successful operations, and are associated with extended hospital stay, extra costs, and high mortality rates. In open surgery the wound's exposure to ambient air increases the risk of wound infection via several independent factors. The open surgical wound is subjected to airborne bacterial contamination, desiccation, and heat loss that increase the bacterial load, cause superficial necrosis, and impair tissue oxygenation and cellular immune functions, respectively. The present hypothesis is that topically applied carbon dioxide in the open surgical wound can be used intraoperatively to avoid these risks, and thus help to prevent postoperative wound infection. We also criticize existing methods and describe the theoretical background and supporting evidence for our suggested method. If the hypothesis would prove to be correct in a clinical trial, the new method may be an effective complement, or even an alternative, to antibiotics in preventing surgical site infection.
[Show abstract] [Hide abstract] ABSTRACT: Flow within a model surgical opening during insufflation with heated carbon dioxide was studied using computational fluid dynamics. A volume of fluid method was used to simulate the mixture of ambient air and carbon dioxide gas. The negative buoyancy of the carbon dioxide caused it to fill the wound and form a protective layer on the internal surfaces for a range of flow rates, temperatures, and angles of patient inclination. It was observed that the flow remained attached to the surface of the model due to the action of the Coanda effect. A flow rate of 10L/min was sufficient to maintain a warm carbon dioxide barrier for a moderately sized surgical incision for all likely angles of inclination.0Comments 1Citation
- "If heated and fully humidified, the insufflated CO 2 warms the wound further and also prevents evaporation from the wound surfaces, which otherwise will cause cooling of the wound when it is exposed to relatively dry ambient air . Other proposed mechanisms of action include decreased airborne con- tamination [6,7], reduced bacterial growth , and improved tissue oxygenation . The method is dependent on a gas insufflation device that creates a local atmosphere of CO 2 in the open wound, covering the inner surfaces . "
- [Show abstract] [Hide abstract] ABSTRACT: Carbon dioxide is a fundamental biological gas and due to its unique properties it is frequently used as a medical gas. In minimally invasive surgery carbon dioxide is insufflated into the "closed" surgical wound to facilitate laparoscopy. Furthermore, a method has recently been developed to create a local atmosphere of 100% carbon dioxide in an open wound to prevent air embolism and ensuing neurological impairment in open heart surgery. In the present paper the authors propose that carbon dioxide also may be used as a carrier gas for delivery of potent medical agents into a wound. With theoretical and experimental arguments the authors explain why carbon dioxide should be suitable for this purpose, and describe the potential advantages and implications of the suggested method.0Comments 2Citations
- [Show abstract] [Hide abstract] ABSTRACT: Postoperative adhesion formation is a common, serious, and costly complication, which may cause organ dysfunction, difficult re-operations, and chronic pain. The formation of adhesions after open surgery is partly due to the perioperative exposure of the wound cavity to ambient air, which initiates various local processes that cause inflammation and cellular damage in mesothelial layers. These adhesiogenic processes include superficial desiccation, airborne bacterial contamination and subsequent wound infection, and exposure to atmospheric oxygen with ensuing hyperoxia and oxidative stress. Here, we describe how recent results from experimental surgical research imply that the adverse effects of air exposure during open surgery could be prevented by the use of intraoperative field flooding with warm and humidified carbon dioxide. If proven effective in a clinical trial, a decreased incidence of postsurgical adhesions would thus save a lot of suffering, time, and money for the patients and the healthcare system.0Comments 6Citations