Compartment Pressure Monitoring After Thyroid Surgery: A Possible Method to Detect a Rebleeding

Ahnen, Thomas von; Ahnen, Martin von; Militz, Sonja; Preußer, Dana; Wirth, Ulrike; Schardey, H. M.; Schöpf, Stefan

doi:10.1007/s00268-017-4020-9

Cited by 14 publications

(21 citation statements)

References 36 publications

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“…Especially with the ongoing discussion about outpatient thyroid surgery and increasing numbers of remote access surgical procedures in thyroid surgery, a reliable remote patient surveillance will be necessary to maintain patients' safety. We previously demonstrated that postoperative continuous cervical pressure monitoring might be feasible and a reliable tool to increase patients' safety in thyroid surgery (14). Based on our findings and previous published data, the severity of post thyroidectomy hemorrhage depends on the type and dynamics of the underlaying bleeding, but most post- Value thyroidectomy hemorrhages occur due to arterial and less often to venous bleeding sources (2)(3)(4)6,11,14).…”

Section: Discussionmentioning

confidence: 55%

“…Due to the correlation of increased pressure and impairment of perfusion and function in any compartment syndrome, the diagnosis of a compartment syndrome is made either clinically or by well-established single or repeated invasive pressure measurements (29,30). Novel concepts like continuous pressure monitoring might be a much faster and more reliable parameter (14) as the only rational therapy of post thyroidectomy hemorrhage and any other compartment syndrome is a release of the increased pressure by re-opening the wound and/or surgical intervention as fast as possible (1)(2)(3)(4)6,11,14,29,30).…”

Section: Discussionmentioning

confidence: 99%

“…Previously, we could demonstrate in ex-vivo human cadaver tracheas that pressure levels of more than 150 mmHg are required to cause relevant mechanical tracheal obstruction (13). We previously reported on four symptomatic patients with post thyroidectomy hemorrhage and increased cervical compartment pressure between 20 and 40 mmHg at time of revision surgery (14). Therefore, even in arterial hemorrhage, pressure levels of more than 100 mmHg are unlikely to be reached.…”

Section: Introductionmentioning

confidence: 98%

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A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model

Wirth¹,

Schardey²,

Bonleitner³

et al. 2022

Gland Surg

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Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model

Wirth¹,

Schardey²,

Bonleitner³

et al. 2022

Gland Surg

Self Cite

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“…However, because ordinary smartphones often forget to bring data, the data is not comprehensive. The self-learning activity recognition program does not immature [3]. Mchenry explained the research status of the medical monitoring systems from the aspects of mobile medical treatment, physiological index testing equipment, medical institution-level monitoring system, home monitoring system, etc.…”

Section: Introductionmentioning

confidence: 99%

Medical Monitoring and Management System of Mobile Thyroid Surgery Based on Internet of Things and Cloud Computing

Kong

Chen

2021

Wireless Communications and Mobile Computing

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With the rapid development of the Internet of Things and cloud computing technologies, the Internet of Things technology based on comprehensive perception and interconnection and cloud computing based on virtualization, dynamic resources, and parallel computing have become the driving force for the innovation and development of informatization and intelligence. The cloud-based Internet of Things mobile medical is an ecosystem of health information and medical information, with the medical Internet of Things at its core and highly mobile and highly shared information. Therefore, in the context of in-depth research on mobile medical care, research on mobile postoperative thyroid monitoring and management systems based on the Internet of Things and cloud computing is a practical tool for promoting the development of mobile medical systems. Monitoring and Management. In this experiment, 48 cases of patients undergoing thyroid surgery were selected from a hospital. The experimental group was informed by the experiment that they need to be equipped with sensors. The control panel and GPS positioning module are used to obtain the exact position of the patient at the first time. The loading of the sensor is agreed by the patient and the patient’s family. Afterward, the control group will not be processed. It will conduct functional tests and software performance tests on the mobile medical monitoring and management system and analyze the satisfaction of medical staff with the mobile medical monitoring and management system. Experiments have proved that the cloud computing medical monitoring and management system is used to obtain the exact location of the patient in the first time, and the response time needs to be shorter. The response time of the system increases with the increase of the number of sensors ( P < 0.05 ), which shows that the mobile medical monitoring and management system is essential for medical care and medical care. Obtaining the exact position of the patient for the first time is of great importance for the successful rescue of the patient.

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“…In this part of the body, the correct postoperative pressure on tissue should be no more than approximately 10 mmHg. This limit represents the value of the postoperative pressure for detecting wound re-bleeding 20,21 and in recognizing neck compartment syndrome 22 . Similarly, the value of capillary pulse pressure amplitude ranges from approximately 0.5 to 12 mmHg 23,24 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an Electro-Pneumatic Device for Artificial Capillary Pulse Generation used in a Prospective Study in Animals for Surgical Neck Wound Healing

Foltyn¹,

Proto

Oczka

et al. 2019

Sci Rep

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The paper examines the development and testing of an electro-pneumatic device for wound healing therapy after surgery in the neck area. The device generates air pressure values in a miniaturized cuff using electronic circuitry to drive an electro-valve and air compressor. The device works in two distinct modes: continuous pressure mode and pulsating pressure mode. The pressure value setting can vary from 3 to 11 mmHg, and the pulsating pressure mode’s operating frequency range is approximately 0.1 to 0.3 Hz. Laboratory measurements were conducted to evaluate the device’s correct functioning in both continuous and pulsating pressure modes. A four-day prospective study with animals ( n = 10) was also conducted to evaluate neck wound healing therapy using the electro-pneumatic device. Out of the twelve histological parameters analysed to reveal the differences between the experimental and control wounds, only one demonstrated a significant difference. Out of the ten animals treated with the device, three showed a significant difference in terms of benefit after therapy. We can therefore conclude that the device potentially improves the wound healing process in the neck area if the pre-set air pressure value does not exceed 8 mmHg.

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Compartment Pressure Monitoring After Thyroid Surgery: A Possible Method to Detect a Rebleeding

Cited by 14 publications

References 36 publications

A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model

A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model

Medical Monitoring and Management System of Mobile Thyroid Surgery Based on Internet of Things and Cloud Computing

Evaluation of an Electro-Pneumatic Device for Artificial Capillary Pulse Generation used in a Prospective Study in Animals for Surgical Neck Wound Healing

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