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Arachchi A, Lee A, Metlapalli M, Antoniou E, Rajan R, Narasimhan V, Rajagopalan A, Key S, Teoh WMK, Nguyen TC, Lim JTH, Chouhan H, Waxman BP, Smith JA. Does intra-operative humidification with warmed CO 2 reduce surgical site infection in open colorectal surgery? A randomized control trial. ANZ J Surg 2022; 93:970-979. [PMID: 36259219 DOI: 10.1111/ans.18116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUNDS Surgical site infections (SSI) are a significant cause of postoperative morbidity and mortality, contributing to a considerable financial burden on the healthcare system. Insufflation of the open surgical wound with warm, humidified carbon dioxide (CO2 ) is a novel measure aimed to reduce SSI. The local atmosphere of warm, humidified CO2 within the open surgical wound is proposed to decrease airborne contamination, bacterial growth, desiccation, and heat loss while improving tissue oxygenation and perfusion. This randomized controlled trial evaluates the impact of the HumiGard™ surgical humidification system on the incidence of SSI in patients undergoing open colorectal surgery. METHODS We conducted a multi-site single-blinded randomized control trial on patients undergoing elective or emergency laparotomy at a single tertiary Colorectal Surgery service. The primary outcome measure was the incidence of SSI, with secondary outcomes including ICU length of stay (LOS), total LOS and mean core temperature. RESULTS Patients who received HumiGard™ had a lower incidence of SSI, although this did not reach statistical significance (4.5% for treatment group versus 13.0% for control group; P = 0.092). There was no significant difference in ICU LOS or total LOS between cohorts. The HumiGard™ group had a higher mean core temperature than the control at the end of surgery (P < 0.001). CONCLUSION The present study could not confirm that utilization of warm, humidified CO2 with HumiGard™ reduces SSI in open colorectal surgery. Further research is indicated to validate and extend these findings.
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Affiliation(s)
- Asiri Arachchi
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Alice Lee
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Manisha Metlapalli
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ellathios Antoniou
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Ruben Rajan
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ashray Rajagopalan
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Seraphina Key
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - William M K Teoh
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Thang Chien Nguyen
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - James Tow-Hing Lim
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Hanumant Chouhan
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Bruce P Waxman
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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4
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Sampurno S, Chittleborough T, Dean M, Flood M, Carpinteri S, Roth S, Millen RM, Cain H, Kong JCH, MacKay J, Warrier SK, McCormick J, Hiller JG, Heriot AG, Ramsay RG, Lynch AC. Effect of Surgical Humidification on Inflammation and Peritoneal Trauma in Colorectal Cancer Surgery: A Randomized Controlled Trial. Ann Surg Oncol 2022; 29:7911-7920. [PMID: 35794366 PMCID: PMC9261208 DOI: 10.1245/s10434-022-12057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pre-clinical studies indicate that dry-cold-carbon-dioxide (DC-CO2) insufflation leads to more peritoneal damage, inflammation and hypothermia compared with humidified-warm-CO2 (HW-CO2). Peritoneum and core temperature in patients undergoing colorectal cancer (CRC) surgery were compared. METHODS Sixty-six patients were randomized into laparoscopic groups; those insufflated with DC-CO2 or HW-CO2. A separate group of nineteen patients undergoing laparotomy were randomised to conventional surgery or with the insertion of a device delivering HW-CO2. Temperatures were monitored and peritoneal biopsies and bloods were taken at the start of surgery, at 1 and 3 h. Further bloods were taken depending upon hospital length-of-stay (LOS). Peritoneal samples were subjected to scanning electron microscopy to evaluate mesothelial damage. RESULTS Laparoscopic cases experienced a temperature drop despite Bair-HuggerTM use. HW-CO2 restored normothermia (≥ 36.5 °C) by 3 h, DC-CO2 did not. LOS was shorter for colon compared with rectal cancer cases and if insufflated with HW-CO2 compared with DC-CO2; 5.0 vs 7.2 days, colon and 11.6 vs 15.4 days rectum, respectively. Unexpectedly, one third of patients had pre-existing damage. Damage increased at 1 and 3 h to a greater extent in the DC-CO2 compared with the HW-CO2 laparoscopic cohort. C-reactive protein levels were higher in open than laparoscopic cases and lower in both matched HW-CO2 groups. CONCLUSIONS This prospective RCT is in accord with animal studies while highlighting pre-existing damage in some patients. Peritoneal mesothelium protection, reduced inflammation and restoration of core-body temperature data suggest benefit with the use of HW-CO2 in patients undergoing CRC surgery.
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Affiliation(s)
- Shienny Sampurno
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Timothy Chittleborough
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Meara Dean
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Michael Flood
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Sandra Carpinteri
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Sara Roth
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Rosemary M Millen
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Helen Cain
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Joseph C H Kong
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - John MacKay
- Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Satish K Warrier
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Jacob McCormick
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Jonathon G Hiller
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Alexander G Heriot
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Robert G Ramsay
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia. .,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia. .,Epworth Healthcare, Richmond Victoria, Richmond, Australia.
| | - Andrew C Lynch
- Epworth Healthcare, Richmond Victoria, Richmond, Australia
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