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A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model
Post thyroidectomy hemorrhage is a potentially life-threatening complication. As the mechanism leading to hypoxemic brain damage and death is still unknown, our aim was to examine the underlaying pathophysiology in an animal model. A series of experiments was performed in our established model for p...
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Published in: | Gland surgery 2022-04, Vol.11 (4), p.651-662 |
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creator | Wirth, Ulrich Schardey, Josefine Bonleitner, Magdalena Weber, Desiree von Ahnen, Thomas Ladurner, Roland Andrassy, Joachim Werner, Jens Schardey, Hans Martin Schopf, Stefan |
description | Post thyroidectomy hemorrhage is a potentially life-threatening complication. As the mechanism leading to hypoxemic brain damage and death is still unknown, our aim was to examine the underlaying pathophysiology in an animal model.
A series of experiments was performed in our established model for post thyroidectomy hemorrhage in 6 pigs. First, post thyroidectomy hemorrhage was simulated with an artificial increase of cervical compartment pressure. Second, spontaneous bleeding into the cervical compartment was initiated. Primary outcome measure is the correlation between cerebral oxygenation and cervical compartment pressure.
With an increase in cervical compartment pressure apnea could be detected in all experiments. A significant 24.2% (9.5-34.4%) decrease of cerebral oxygenation at time of apnea (47.0%; 38.0-65.0%) compared to baseline values (63.5%; 56.0-74.0%; P=0.043) occurred due increase of cervical compartment pressure concurrent with an impaired cerebral perfusion. Apnea occurred about 200 sec after a 10% decrease of cerebral oxygenation, but 35 sec before a 10% decrease of peripheral oxygenation. Spontaneous bleeding into the cervical compartment causes an increase of cervical compartment pressure reaching levels of the mean arterial blood pressure 56.0 (35.0-72.0) mmHg.
Peripheral hypoxemia occurs with relevant delay in time after decrease of cerebral perfusion and cerebral hypoxemia, therefore cerebral hypoxemia seems to be causal for a central apnea. With this evidence of impaired cerebral perfusion and cerebral hypoxemia due to an increased cervical compartment pressure we can disprove the historic theory of tracheal collapse due to a compressive hematoma in post thyroidectomy hemorrhage. A cervical compartment syndrome seems to be causal, not only for brain hypoxemia but also an additional laryngo-pharyngeal mucosal edema. |
doi_str_mv | 10.21037/gs-21-910 |
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A series of experiments was performed in our established model for post thyroidectomy hemorrhage in 6 pigs. First, post thyroidectomy hemorrhage was simulated with an artificial increase of cervical compartment pressure. Second, spontaneous bleeding into the cervical compartment was initiated. Primary outcome measure is the correlation between cerebral oxygenation and cervical compartment pressure.
With an increase in cervical compartment pressure apnea could be detected in all experiments. A significant 24.2% (9.5-34.4%) decrease of cerebral oxygenation at time of apnea (47.0%; 38.0-65.0%) compared to baseline values (63.5%; 56.0-74.0%; P=0.043) occurred due increase of cervical compartment pressure concurrent with an impaired cerebral perfusion. Apnea occurred about 200 sec after a 10% decrease of cerebral oxygenation, but 35 sec before a 10% decrease of peripheral oxygenation. Spontaneous bleeding into the cervical compartment causes an increase of cervical compartment pressure reaching levels of the mean arterial blood pressure 56.0 (35.0-72.0) mmHg.
Peripheral hypoxemia occurs with relevant delay in time after decrease of cerebral perfusion and cerebral hypoxemia, therefore cerebral hypoxemia seems to be causal for a central apnea. With this evidence of impaired cerebral perfusion and cerebral hypoxemia due to an increased cervical compartment pressure we can disprove the historic theory of tracheal collapse due to a compressive hematoma in post thyroidectomy hemorrhage. A cervical compartment syndrome seems to be causal, not only for brain hypoxemia but also an additional laryngo-pharyngeal mucosal edema.</description><identifier>ISSN: 2227-684X</identifier><identifier>EISSN: 2227-8575</identifier><identifier>DOI: 10.21037/gs-21-910</identifier><identifier>PMID: 35531110</identifier><language>eng</language><publisher>China (Republic : 1949- ): AME Publishing Company</publisher><subject>Original</subject><ispartof>Gland surgery, 2022-04, Vol.11 (4), p.651-662</ispartof><rights>2022 Gland Surgery. All rights reserved.</rights><rights>2022 Gland Surgery. All rights reserved. 2022 Gland Surgery.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-cd6fcdea4c9795244c37207a53de2c661d4b5df07c0075a708438eee01ae77a33</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9068534/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9068534/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35531110$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wirth, Ulrich</creatorcontrib><creatorcontrib>Schardey, Josefine</creatorcontrib><creatorcontrib>Bonleitner, Magdalena</creatorcontrib><creatorcontrib>Weber, Desiree</creatorcontrib><creatorcontrib>von Ahnen, Thomas</creatorcontrib><creatorcontrib>Ladurner, Roland</creatorcontrib><creatorcontrib>Andrassy, Joachim</creatorcontrib><creatorcontrib>Werner, Jens</creatorcontrib><creatorcontrib>Schardey, Hans Martin</creatorcontrib><creatorcontrib>Schopf, Stefan</creatorcontrib><title>A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model</title><title>Gland surgery</title><addtitle>Gland Surg</addtitle><description>Post thyroidectomy hemorrhage is a potentially life-threatening complication. As the mechanism leading to hypoxemic brain damage and death is still unknown, our aim was to examine the underlaying pathophysiology in an animal model.
A series of experiments was performed in our established model for post thyroidectomy hemorrhage in 6 pigs. First, post thyroidectomy hemorrhage was simulated with an artificial increase of cervical compartment pressure. Second, spontaneous bleeding into the cervical compartment was initiated. Primary outcome measure is the correlation between cerebral oxygenation and cervical compartment pressure.
With an increase in cervical compartment pressure apnea could be detected in all experiments. A significant 24.2% (9.5-34.4%) decrease of cerebral oxygenation at time of apnea (47.0%; 38.0-65.0%) compared to baseline values (63.5%; 56.0-74.0%; P=0.043) occurred due increase of cervical compartment pressure concurrent with an impaired cerebral perfusion. Apnea occurred about 200 sec after a 10% decrease of cerebral oxygenation, but 35 sec before a 10% decrease of peripheral oxygenation. Spontaneous bleeding into the cervical compartment causes an increase of cervical compartment pressure reaching levels of the mean arterial blood pressure 56.0 (35.0-72.0) mmHg.
Peripheral hypoxemia occurs with relevant delay in time after decrease of cerebral perfusion and cerebral hypoxemia, therefore cerebral hypoxemia seems to be causal for a central apnea. With this evidence of impaired cerebral perfusion and cerebral hypoxemia due to an increased cervical compartment pressure we can disprove the historic theory of tracheal collapse due to a compressive hematoma in post thyroidectomy hemorrhage. A cervical compartment syndrome seems to be causal, not only for brain hypoxemia but also an additional laryngo-pharyngeal mucosal edema.</description><subject>Original</subject><issn>2227-684X</issn><issn>2227-8575</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNpVkU9LJDEQxYMoKurFDyA5itBr_na6PQgiuisIXhS8hUxSPRPpdMYkIzvffuM6ikIgoeqXV694CB1T8otRwtX5PDeMNj0lW2ifMaaaTiq5vXm3nXjeQ0c5vxBCKGeibdku2uNSckop2Ud_r7CF9OatGbGNYWlSCTAVnNeTSzEA9rXmU36nYJbeKZ_sajTFxwn7CS9jLk1ZrFP0DmyJYY0XEGJKCzOHC-xMMXioSthM9fhQFUJ0MB6incGMGY429wF6ur15vP7T3D_8vru-um8sV11prGsH68AI26teMiFqmRFlJHfAbNtSJ2bSDURZQpQ0inSCdwBAqAGlDOcH6PJDd7maBXC2Lle30MtUraS1jsbrn53JL_Q8vumetJ3kogqcbgRSfF1BLjr4bGEczQRxlTWrJkTHek4qevaB2hRzTjB8jaFE_09Lz-sHqmtaFT75buwL_cyG_wPUf5N8</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Wirth, Ulrich</creator><creator>Schardey, Josefine</creator><creator>Bonleitner, Magdalena</creator><creator>Weber, Desiree</creator><creator>von Ahnen, Thomas</creator><creator>Ladurner, Roland</creator><creator>Andrassy, Joachim</creator><creator>Werner, Jens</creator><creator>Schardey, Hans Martin</creator><creator>Schopf, Stefan</creator><general>AME Publishing Company</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220401</creationdate><title>A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model</title><author>Wirth, Ulrich ; Schardey, Josefine ; Bonleitner, Magdalena ; Weber, Desiree ; von Ahnen, Thomas ; Ladurner, Roland ; Andrassy, Joachim ; Werner, Jens ; Schardey, Hans Martin ; Schopf, Stefan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c378t-cd6fcdea4c9795244c37207a53de2c661d4b5df07c0075a708438eee01ae77a33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Original</topic><toplevel>online_resources</toplevel><creatorcontrib>Wirth, Ulrich</creatorcontrib><creatorcontrib>Schardey, Josefine</creatorcontrib><creatorcontrib>Bonleitner, Magdalena</creatorcontrib><creatorcontrib>Weber, Desiree</creatorcontrib><creatorcontrib>von Ahnen, Thomas</creatorcontrib><creatorcontrib>Ladurner, Roland</creatorcontrib><creatorcontrib>Andrassy, Joachim</creatorcontrib><creatorcontrib>Werner, Jens</creatorcontrib><creatorcontrib>Schardey, Hans Martin</creatorcontrib><creatorcontrib>Schopf, Stefan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Gland surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wirth, Ulrich</au><au>Schardey, Josefine</au><au>Bonleitner, Magdalena</au><au>Weber, Desiree</au><au>von Ahnen, Thomas</au><au>Ladurner, Roland</au><au>Andrassy, Joachim</au><au>Werner, Jens</au><au>Schardey, Hans Martin</au><au>Schopf, Stefan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model</atitle><jtitle>Gland surgery</jtitle><addtitle>Gland Surg</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>11</volume><issue>4</issue><spage>651</spage><epage>662</epage><pages>651-662</pages><issn>2227-684X</issn><eissn>2227-8575</eissn><abstract>Post thyroidectomy hemorrhage is a potentially life-threatening complication. As the mechanism leading to hypoxemic brain damage and death is still unknown, our aim was to examine the underlaying pathophysiology in an animal model.
A series of experiments was performed in our established model for post thyroidectomy hemorrhage in 6 pigs. First, post thyroidectomy hemorrhage was simulated with an artificial increase of cervical compartment pressure. Second, spontaneous bleeding into the cervical compartment was initiated. Primary outcome measure is the correlation between cerebral oxygenation and cervical compartment pressure.
With an increase in cervical compartment pressure apnea could be detected in all experiments. A significant 24.2% (9.5-34.4%) decrease of cerebral oxygenation at time of apnea (47.0%; 38.0-65.0%) compared to baseline values (63.5%; 56.0-74.0%; P=0.043) occurred due increase of cervical compartment pressure concurrent with an impaired cerebral perfusion. Apnea occurred about 200 sec after a 10% decrease of cerebral oxygenation, but 35 sec before a 10% decrease of peripheral oxygenation. Spontaneous bleeding into the cervical compartment causes an increase of cervical compartment pressure reaching levels of the mean arterial blood pressure 56.0 (35.0-72.0) mmHg.
Peripheral hypoxemia occurs with relevant delay in time after decrease of cerebral perfusion and cerebral hypoxemia, therefore cerebral hypoxemia seems to be causal for a central apnea. With this evidence of impaired cerebral perfusion and cerebral hypoxemia due to an increased cervical compartment pressure we can disprove the historic theory of tracheal collapse due to a compressive hematoma in post thyroidectomy hemorrhage. A cervical compartment syndrome seems to be causal, not only for brain hypoxemia but also an additional laryngo-pharyngeal mucosal edema.</abstract><cop>China (Republic : 1949- )</cop><pub>AME Publishing Company</pub><pmid>35531110</pmid><doi>10.21037/gs-21-910</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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title | A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model |
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