Pathophysiology of airway obstruction caused by wound hematoma after thyroidectomy: an ex vivo study

Abstract

Background Airway obstruction by postoperative hemorrhage after thyroid resection is a serious adverse and potentially life-threatening event. The aim of this study is to investigate if the possible pressure caused by a postoperative hematoma in the neck would be sufficient to compress the trachea and therefore leads to a mechanical airway obstruction.Methods In this ex vivo model varying pressures (0-250 mmHg) were applied on 30 human cadaver tracheas. The primary outcome was the anterior-posterior and latero-lateral tracheal diameter during the application of different pressures.Results At the highest pressures of 250 mmHg, there was an average compression of only 67.80 % in anterior-posterior direction and of 60.09 % in latero-lateral direction.Conclusions This study suggests that even pressures of 250 mmHg in neck-hematomas would be insufficient to cause a mechanical airway occlusion.Pathophysiology of airway obstruction caused by wound hematoma after thyroidectomy: an ex vivo study T. von Ahnen · M. von Ahnen · U. Wirth · A. Schroll · H. M. Schardey · S. Schopf Original Article 2 Pathophysiology of airway obstruction caused by wound hematoma after thyroidectomy: an ex vivo study

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

“…A mean pressure above 227 mmHg is needed to cause a compression of the trachea between 20.8 and 100% [9, 11, 13]. Compartment pressure above 200 mmHg cannot be reached in the lower leg [14] and probably not in the neck.…”

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

“…Additionally, the venous drainage must be impaired because of the simultaneously increased pressure in the internal jugular vein. The increased cervical compartment pressure almost reaching the mean arterial blood pressure is not sufficient for a relevant airway compression as reported previously (13). Therefore, a compartment syndrome could explain the mechanism for the decrease in cerebral oxygenation due an increasing cervical compartment pressure.…”

“…Harding et al earlier disproved the hypothesis of external airway obstruction and suggested a multifactorial pathogenesis (12). 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).…”

Surgery with qualities or: “how to foster yourself”

“…The authors of the present issue of European Surgery compose an harmonic symphony of themes and directories reflecting different approaches to the world of surgery and basic science [5][6][7][8][9][10]. In addition, the articles sense the highly positive notion, that there can be short lights of true awareness, off the power-tuned path of the despotism-driven "normal" life within the academy.…”

“…In addition, the articles sense the highly positive notion, that there can be short lights of true awareness, off the power-tuned path of the despotism-driven "normal" life within the academy. The colorful spectrum of papers ranges from molecular to clinical science, from open to laparoscopic and minimally invasive surgery [5][6][7][8][9][10]. The globe of variations indicates that there exist amigos out there in the surgical community who have NOT given up to raise questions, who have NOT given up their wish to discover and to understand and tune themselves with the golden shine (Fig.…”