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Donald A. Hudson - One of the best experts on this subject based on the ideXlab platform.
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Negative-Pressure Wound Therapy I: The Paradox of Negative-Pressure Wound Therapy
Wound Healing Southern Africa, 2017Co-Authors: Nicolas Kairinos, Michael Solomons, Donald A. HudsonAbstract:Background: Does Negative-Pressure wound therapy reduce or increase the Pressure of wound tissues? This seemingly obvious question has never been addressed by a study on living tissues. The aim of this study was to evaluate the nature of tissue Pressure changes in relation to Negative-Pressure wound therapy. Methods: Three Negative-Pressure wound therapy dressing configurations were evaluated - circumferential, noncircumferential, and those within a cavity - on 15 human wounds, with five wounds in each category. Tissue Pressure changes were recorded (using a strain gauge sensor) for each 75-mmHg increment in suction, up to 450 mmHg. In the circumferential and noncircumferential groups, tissue Pressure was also measured over a 48-hour period at a set suction Pressure of 125 mmHg ( n = 10). Results: In all three groups, mean tissue Pressure increased proportionately to the amount of suction applied ( p p p p = 0.269). Over the 48-hour period, there was a significant mean reduction in the (increased) tissue Pressure ( p p Conclusions: Negative-Pressure wound therapy increases tissue Pressure proportionately to the amount of suction, although this becomes less pronounced over 48 hours. This suggests that Negative-Pressure wound therapy dressings should be used with caution on tissues with compromised perfusion, particularly when they are circumferential.
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Negative Pressure wound therapy ii Negative Pressure wound therapy and increased perfusion just an illusion
Plastic and Reconstructive Surgery, 2009Co-Authors: Nicolas Kairinos, Donald A. Hudson, Anda M Voogd, Pieter H Botha, Tessa Kotze, Delawir Kahn, Michael SolomonsAbstract:BACKGROUND: A recent study demonstrated that Negative-Pressure wound therapy increases underlying tissue Pressure. This finding is incongruous with studies using laser Doppler that show that perfusion is immediately increased on initiation of suction. This study investigated perfusion in Negative-Pressure wound therapy using two alternative modalities. METHODS: Radioisotope perfusion imaging was used to determine perfusion beneath circumferential Negative-Pressure wound therapy dressings on 20 healthy hands (n = 20). Ten hands received suction Pressures of -400 mmHg and 10 received -125 mmHg, with the contralateral hand used as a control without any suction. Transcutaneous partial Pressure of oxygen was used to determine perfusion beneath noncircumferential Negative-Pressure wound therapy dressings on 12 healthy legs (n = 12), with each volunteer being sequentially randomized to receive suction Pressures of -400 and -125 mmHg, respectively. RESULTS: Tissues undergoing circumferential Negative-Pressure wound therapy demonstrated a mean reduction in perfusion of 40 +/- 11.5 percent (p < 0.0005) and 17 +/- 8.9 percent (p < 0.0005) at suction Pressures of -400 mmHg and -125 mmHg, respectively. Perfusion reduction at -400 mmHg was significantly greater than at -125 mmHg (p < 0.015). In the noncircumferential Negative-Pressure wound therapy group, there was a mean reduction in transcutaneous partial Pressure of oxygen of 7.35 +/- 7.4 mmHg (p < 0.0005) and 5.10 +/- 7.4 mmHg (p < 0.0005) at suction Pressures of -400 mmHg and -125 mmHg, respectively. There was a tendency for greater reductions in the -400 mmHg group, but this was not significantly different from the -125 mmHg group (p = 0.07). CONCLUSIONS: These findings demonstrate that perfusion beneath Negative-Pressure wound therapy decreases for increasing suction Pressure. Thus, it is suggested that Negative-Pressure wound therapy should be used with caution on tissues with compromised vascularity, particularly when used circumferentially.
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Negative-Pressure wound therapy I: the paradox of Negative-Pressure wound therapy.
Plastic and reconstructive surgery, 2009Co-Authors: Nicolas Kairinos, Michael Solomons, Donald A. HudsonAbstract:BACKGROUND Does Negative-Pressure wound therapy reduce or increase the Pressure of wound tissues? This seemingly obvious question has never been addressed by a study on living tissues. The aim of this study was to evaluate the nature of tissue Pressure changes in relation to Negative-Pressure wound therapy. METHODS Three Negative-Pressure wound therapy dressing configurations were evaluated-circumferential, noncircumferential, and those within a cavity-on 15 human wounds, with five wounds in each category. Tissue Pressure changes were recorded (using a strain gauge sensor) for each 75-mmHg increment in suction, up to -450 mmHg. In the circumferential and noncircumferential groups, tissue Pressure was also measured over a 48-hour period at a set suction Pressure of -125 mmHg (n = 10). RESULTS In all three groups, mean tissue Pressure increased proportionately to the amount of suction applied (p < 0.0005). Mean tissue Pressure increments resulting from the circumferential dressings were significantly higher than those resulting from the noncircumferential (p < 0.0005) or cavity group (p < 0.0005); however, there was no significant difference between the latter two groups (p = 0.269). Over the 48-hour period, there was a significant mean reduction in the (increased) tissue Pressure (p < 0.04 for circumferential and p < 0.0005 for noncircumferential), but in only three of 10 cases did this reduce to Pressures less than those before dressing application. CONCLUSIONS Negative-Pressure wound therapy increases tissue Pressure proportionately to the amount of suction, although this becomes less pronounced over 48 hours. This suggests that Negative-Pressure wound therapy dressings should be used with caution on tissues with compromised perfusion, particularly when they are circumferential.
Nicolas Kairinos - One of the best experts on this subject based on the ideXlab platform.
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Negative-Pressure Wound Therapy I: The Paradox of Negative-Pressure Wound Therapy
Wound Healing Southern Africa, 2017Co-Authors: Nicolas Kairinos, Michael Solomons, Donald A. HudsonAbstract:Background: Does Negative-Pressure wound therapy reduce or increase the Pressure of wound tissues? This seemingly obvious question has never been addressed by a study on living tissues. The aim of this study was to evaluate the nature of tissue Pressure changes in relation to Negative-Pressure wound therapy. Methods: Three Negative-Pressure wound therapy dressing configurations were evaluated - circumferential, noncircumferential, and those within a cavity - on 15 human wounds, with five wounds in each category. Tissue Pressure changes were recorded (using a strain gauge sensor) for each 75-mmHg increment in suction, up to 450 mmHg. In the circumferential and noncircumferential groups, tissue Pressure was also measured over a 48-hour period at a set suction Pressure of 125 mmHg ( n = 10). Results: In all three groups, mean tissue Pressure increased proportionately to the amount of suction applied ( p p p p = 0.269). Over the 48-hour period, there was a significant mean reduction in the (increased) tissue Pressure ( p p Conclusions: Negative-Pressure wound therapy increases tissue Pressure proportionately to the amount of suction, although this becomes less pronounced over 48 hours. This suggests that Negative-Pressure wound therapy dressings should be used with caution on tissues with compromised perfusion, particularly when they are circumferential.
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Negative Pressure wound therapy ii Negative Pressure wound therapy and increased perfusion just an illusion
Plastic and Reconstructive Surgery, 2009Co-Authors: Nicolas Kairinos, Donald A. Hudson, Anda M Voogd, Pieter H Botha, Tessa Kotze, Delawir Kahn, Michael SolomonsAbstract:BACKGROUND: A recent study demonstrated that Negative-Pressure wound therapy increases underlying tissue Pressure. This finding is incongruous with studies using laser Doppler that show that perfusion is immediately increased on initiation of suction. This study investigated perfusion in Negative-Pressure wound therapy using two alternative modalities. METHODS: Radioisotope perfusion imaging was used to determine perfusion beneath circumferential Negative-Pressure wound therapy dressings on 20 healthy hands (n = 20). Ten hands received suction Pressures of -400 mmHg and 10 received -125 mmHg, with the contralateral hand used as a control without any suction. Transcutaneous partial Pressure of oxygen was used to determine perfusion beneath noncircumferential Negative-Pressure wound therapy dressings on 12 healthy legs (n = 12), with each volunteer being sequentially randomized to receive suction Pressures of -400 and -125 mmHg, respectively. RESULTS: Tissues undergoing circumferential Negative-Pressure wound therapy demonstrated a mean reduction in perfusion of 40 +/- 11.5 percent (p < 0.0005) and 17 +/- 8.9 percent (p < 0.0005) at suction Pressures of -400 mmHg and -125 mmHg, respectively. Perfusion reduction at -400 mmHg was significantly greater than at -125 mmHg (p < 0.015). In the noncircumferential Negative-Pressure wound therapy group, there was a mean reduction in transcutaneous partial Pressure of oxygen of 7.35 +/- 7.4 mmHg (p < 0.0005) and 5.10 +/- 7.4 mmHg (p < 0.0005) at suction Pressures of -400 mmHg and -125 mmHg, respectively. There was a tendency for greater reductions in the -400 mmHg group, but this was not significantly different from the -125 mmHg group (p = 0.07). CONCLUSIONS: These findings demonstrate that perfusion beneath Negative-Pressure wound therapy decreases for increasing suction Pressure. Thus, it is suggested that Negative-Pressure wound therapy should be used with caution on tissues with compromised vascularity, particularly when used circumferentially.
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Negative-Pressure wound therapy I: the paradox of Negative-Pressure wound therapy.
Plastic and reconstructive surgery, 2009Co-Authors: Nicolas Kairinos, Michael Solomons, Donald A. HudsonAbstract:BACKGROUND Does Negative-Pressure wound therapy reduce or increase the Pressure of wound tissues? This seemingly obvious question has never been addressed by a study on living tissues. The aim of this study was to evaluate the nature of tissue Pressure changes in relation to Negative-Pressure wound therapy. METHODS Three Negative-Pressure wound therapy dressing configurations were evaluated-circumferential, noncircumferential, and those within a cavity-on 15 human wounds, with five wounds in each category. Tissue Pressure changes were recorded (using a strain gauge sensor) for each 75-mmHg increment in suction, up to -450 mmHg. In the circumferential and noncircumferential groups, tissue Pressure was also measured over a 48-hour period at a set suction Pressure of -125 mmHg (n = 10). RESULTS In all three groups, mean tissue Pressure increased proportionately to the amount of suction applied (p < 0.0005). Mean tissue Pressure increments resulting from the circumferential dressings were significantly higher than those resulting from the noncircumferential (p < 0.0005) or cavity group (p < 0.0005); however, there was no significant difference between the latter two groups (p = 0.269). Over the 48-hour period, there was a significant mean reduction in the (increased) tissue Pressure (p < 0.04 for circumferential and p < 0.0005 for noncircumferential), but in only three of 10 cases did this reduce to Pressures less than those before dressing application. CONCLUSIONS Negative-Pressure wound therapy increases tissue Pressure proportionately to the amount of suction, although this becomes less pronounced over 48 hours. This suggests that Negative-Pressure wound therapy dressings should be used with caution on tissues with compromised perfusion, particularly when they are circumferential.
Michael Solomons - One of the best experts on this subject based on the ideXlab platform.
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Negative-Pressure Wound Therapy I: The Paradox of Negative-Pressure Wound Therapy
Wound Healing Southern Africa, 2017Co-Authors: Nicolas Kairinos, Michael Solomons, Donald A. HudsonAbstract:Background: Does Negative-Pressure wound therapy reduce or increase the Pressure of wound tissues? This seemingly obvious question has never been addressed by a study on living tissues. The aim of this study was to evaluate the nature of tissue Pressure changes in relation to Negative-Pressure wound therapy. Methods: Three Negative-Pressure wound therapy dressing configurations were evaluated - circumferential, noncircumferential, and those within a cavity - on 15 human wounds, with five wounds in each category. Tissue Pressure changes were recorded (using a strain gauge sensor) for each 75-mmHg increment in suction, up to 450 mmHg. In the circumferential and noncircumferential groups, tissue Pressure was also measured over a 48-hour period at a set suction Pressure of 125 mmHg ( n = 10). Results: In all three groups, mean tissue Pressure increased proportionately to the amount of suction applied ( p p p p = 0.269). Over the 48-hour period, there was a significant mean reduction in the (increased) tissue Pressure ( p p Conclusions: Negative-Pressure wound therapy increases tissue Pressure proportionately to the amount of suction, although this becomes less pronounced over 48 hours. This suggests that Negative-Pressure wound therapy dressings should be used with caution on tissues with compromised perfusion, particularly when they are circumferential.
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Negative Pressure wound therapy ii Negative Pressure wound therapy and increased perfusion just an illusion
Plastic and Reconstructive Surgery, 2009Co-Authors: Nicolas Kairinos, Donald A. Hudson, Anda M Voogd, Pieter H Botha, Tessa Kotze, Delawir Kahn, Michael SolomonsAbstract:BACKGROUND: A recent study demonstrated that Negative-Pressure wound therapy increases underlying tissue Pressure. This finding is incongruous with studies using laser Doppler that show that perfusion is immediately increased on initiation of suction. This study investigated perfusion in Negative-Pressure wound therapy using two alternative modalities. METHODS: Radioisotope perfusion imaging was used to determine perfusion beneath circumferential Negative-Pressure wound therapy dressings on 20 healthy hands (n = 20). Ten hands received suction Pressures of -400 mmHg and 10 received -125 mmHg, with the contralateral hand used as a control without any suction. Transcutaneous partial Pressure of oxygen was used to determine perfusion beneath noncircumferential Negative-Pressure wound therapy dressings on 12 healthy legs (n = 12), with each volunteer being sequentially randomized to receive suction Pressures of -400 and -125 mmHg, respectively. RESULTS: Tissues undergoing circumferential Negative-Pressure wound therapy demonstrated a mean reduction in perfusion of 40 +/- 11.5 percent (p < 0.0005) and 17 +/- 8.9 percent (p < 0.0005) at suction Pressures of -400 mmHg and -125 mmHg, respectively. Perfusion reduction at -400 mmHg was significantly greater than at -125 mmHg (p < 0.015). In the noncircumferential Negative-Pressure wound therapy group, there was a mean reduction in transcutaneous partial Pressure of oxygen of 7.35 +/- 7.4 mmHg (p < 0.0005) and 5.10 +/- 7.4 mmHg (p < 0.0005) at suction Pressures of -400 mmHg and -125 mmHg, respectively. There was a tendency for greater reductions in the -400 mmHg group, but this was not significantly different from the -125 mmHg group (p = 0.07). CONCLUSIONS: These findings demonstrate that perfusion beneath Negative-Pressure wound therapy decreases for increasing suction Pressure. Thus, it is suggested that Negative-Pressure wound therapy should be used with caution on tissues with compromised vascularity, particularly when used circumferentially.
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Negative-Pressure wound therapy I: the paradox of Negative-Pressure wound therapy.
Plastic and reconstructive surgery, 2009Co-Authors: Nicolas Kairinos, Michael Solomons, Donald A. HudsonAbstract:BACKGROUND Does Negative-Pressure wound therapy reduce or increase the Pressure of wound tissues? This seemingly obvious question has never been addressed by a study on living tissues. The aim of this study was to evaluate the nature of tissue Pressure changes in relation to Negative-Pressure wound therapy. METHODS Three Negative-Pressure wound therapy dressing configurations were evaluated-circumferential, noncircumferential, and those within a cavity-on 15 human wounds, with five wounds in each category. Tissue Pressure changes were recorded (using a strain gauge sensor) for each 75-mmHg increment in suction, up to -450 mmHg. In the circumferential and noncircumferential groups, tissue Pressure was also measured over a 48-hour period at a set suction Pressure of -125 mmHg (n = 10). RESULTS In all three groups, mean tissue Pressure increased proportionately to the amount of suction applied (p < 0.0005). Mean tissue Pressure increments resulting from the circumferential dressings were significantly higher than those resulting from the noncircumferential (p < 0.0005) or cavity group (p < 0.0005); however, there was no significant difference between the latter two groups (p = 0.269). Over the 48-hour period, there was a significant mean reduction in the (increased) tissue Pressure (p < 0.04 for circumferential and p < 0.0005 for noncircumferential), but in only three of 10 cases did this reduce to Pressures less than those before dressing application. CONCLUSIONS Negative-Pressure wound therapy increases tissue Pressure proportionately to the amount of suction, although this becomes less pronounced over 48 hours. This suggests that Negative-Pressure wound therapy dressings should be used with caution on tissues with compromised perfusion, particularly when they are circumferential.
A N Redington - One of the best experts on this subject based on the ideXlab platform.
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Negative Pressure ventilation improves cardiac output after right heart surgery
Circulation, 1996Co-Authors: Lara S Shekerdemian, Darryl F Shore, C Lincoln, Andrew Bush, A N RedingtonAbstract:Background A low cardiac output state can complicate the postoperative course of patients undergoing Fontan-type operations and tetralogy of Fallot repair. Methods and Results We investigated the effect of Negative-Pressure ventilation on cardiac output in 11 children in the early postoperative period after right heart surgery. All patients were initially ventilated with volume-cycled intermittent positive-Pressure ventilation, and Negative-Pressure ventilation was delivered with the Hayek external high-frequency oscillator. Cardiac output was calculated by the direct Fick method, oxygen consumption being measured by respiratory mass spectrometry. Cardiac output was measured during intermittent positive-Pressure ventilation and after 15 minutes of Negative-Pressure ventilation. Negative-Pressure ventilation improved the cardiac output by a mean of 46% (P=.005). Heart rate did not change, and stroke volume increased by a mean of 48.5% (P=.005). Mixed venous saturation increased by 4.6% (P<.02), and consequently arteriovenous oxygen content difference fell significantly (P=.01). The systemic and pulmonary vascular resistances were reduced significantly during Negative-Pressure ventilation (P<.05 and P<.03, respectively). Conclusions Negative-Pressure ventilation improves cardiac output in children after total cavopulmonary connection and tetralogy of Fallot repair and may prove to be an important therapeutic option in children with the low cardiac output state.
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Negative-Pressure ventilation improves cardiac output after right heart surgery.
Circulation, 1996Co-Authors: Lara S Shekerdemian, Darryl F Shore, C Lincoln, Andrew Bush, A N RedingtonAbstract:A low cardiac output state can complicate the postoperative course of patients undergoing Fontan-type operations and tetralogy of Fallot repair. We investigated the effect of Negative-Pressure ventilation on cardiac output in 11 children in the early postoperative period after right heart surgery. All patients were initially ventilated with volume-cycled intermittent positive-Pressure ventilation, and Negative-Pressure ventilation was delivered with the Hayek external high-frequency oscillator. Cardiac output was calculated by the direct Fick method, oxygen consumption being measured by respiratory mass spectrometry. Cardiac output was measured during intermittent positive-Pressure ventilation and after 15 minutes of Negative-Pressure ventilation. Negative-Pressure ventilation improved the cardiac output by a mean of 46% (P = .005). Heart rate did not change, and stroke volume increased by a mean of 48.5% (P = .005). Mixed venous saturation increased by 4.6% (P < .02), and consequently arteriovenous oxygen content difference fell significantly (P = .01). The systemic and pulmonary vascular resistances were reduced significantly during Negative-Pressure ventilation (P < .05 and P < .03, respectively). Negative-Pressure ventilation improves cardiac output in children after total cavopulmonary connection and tetralogy of Fallot repair and may prove to be an important therapeutic option in children with the low cardiac output state.
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Negative-Pressure ventilation improves cardiac output after right heart surgery.
Circulation, 1996Co-Authors: Lara S Shekerdemian, Darryl F Shore, C Lincoln, Andrew Bush, A N RedingtonAbstract:Background A low cardiac output state can complicate the postoperative course of patients undergoing Fontan-type operations and tetralogy of Fallot repair. Methods and Results We investigated the effect of Negative-Pressure ventilation on cardiac output in 11 children in the early postoperative period after right heart surgery. All patients were initially ventilated with volume-cycled intermittent positive-Pressure ventilation, and Negative-Pressure ventilation was delivered with the Hayek external high-frequency oscillator. Cardiac output was calculated by the direct Fick method, oxygen consumption being measured by respiratory mass spectrometry. Cardiac output was measured during intermittent positive-Pressure ventilation and after 15 minutes of Negative-Pressure ventilation. Negative-Pressure ventilation improved the cardiac output by a mean of 46% (P=.005). Heart rate did not change, and stroke volume increased by a mean of 48.5% (P=.005). Mixed venous saturation increased by 4.6% (P
Howard Kesselman - One of the best experts on this subject based on the ideXlab platform.
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Negative Pressure Pulmonary Hemorrhage
Chest, 1999Co-Authors: David R. Schwartz, Anjli Maroo, Atul Malhotra, Howard KesselmanAbstract:Negative Pressure pulmonary edema, a well-recognized phenomenon, is the formation of pulmonary edema following an acute upper airway obstruction (UAO). To our knowledge, diffuse alveolar hemorrhage has not been reported previously as a complication of an UAO. We describe a case of Negative Pressure pulmonary hemorrhage, and we propose that its etiology is stress failure, the mechanical disruption of the alveolar-capillary membrane.
