Percutaneous aspiration of fluid for management of peritonitis in space

Andrew W. Kirkpatrick, S. Nicolaou, M. R. Campbell, A. E. Sargsyan, S. A. Dulchavsky, S. Melton, G. Beck, David L Dawson, R. D. Billica, S. L. Johnston, D. R. Hamilton

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. Methods: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. Results: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. Conclusions: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.

Original languageEnglish (US)
Pages (from-to)925-930
Number of pages6
JournalAviation Space and Environmental Medicine
Volume73
Issue number9
StatePublished - Sep 2002
Externally publishedYes

Fingerprint

Weightlessness
Ascitic Fluid
Peritonitis
Space Flight
Treatment Failure
Fluids
Microgravity
United States National Aeronautics and Space Administration
Viscera
Aircraft
Peritoneal Cavity
Research aircraft
Needles
Catheters
Emergencies
Weighing
Swine
Pharmacology
Gages
NASA

Keywords

  • Percutaneous drainage
  • Peritonitis
  • Space flight
  • Surgery
  • Weightlessness

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Pollution
  • Medicine(all)

Cite this

Kirkpatrick, A. W., Nicolaou, S., Campbell, M. R., Sargsyan, A. E., Dulchavsky, S. A., Melton, S., ... Hamilton, D. R. (2002). Percutaneous aspiration of fluid for management of peritonitis in space. Aviation Space and Environmental Medicine, 73(9), 925-930.

Percutaneous aspiration of fluid for management of peritonitis in space. / Kirkpatrick, Andrew W.; Nicolaou, S.; Campbell, M. R.; Sargsyan, A. E.; Dulchavsky, S. A.; Melton, S.; Beck, G.; Dawson, David L; Billica, R. D.; Johnston, S. L.; Hamilton, D. R.

In: Aviation Space and Environmental Medicine, Vol. 73, No. 9, 09.2002, p. 925-930.

Research output: Contribution to journalArticle

Kirkpatrick, AW, Nicolaou, S, Campbell, MR, Sargsyan, AE, Dulchavsky, SA, Melton, S, Beck, G, Dawson, DL, Billica, RD, Johnston, SL & Hamilton, DR 2002, 'Percutaneous aspiration of fluid for management of peritonitis in space', Aviation Space and Environmental Medicine, vol. 73, no. 9, pp. 925-930.
Kirkpatrick AW, Nicolaou S, Campbell MR, Sargsyan AE, Dulchavsky SA, Melton S et al. Percutaneous aspiration of fluid for management of peritonitis in space. Aviation Space and Environmental Medicine. 2002 Sep;73(9):925-930.
Kirkpatrick, Andrew W. ; Nicolaou, S. ; Campbell, M. R. ; Sargsyan, A. E. ; Dulchavsky, S. A. ; Melton, S. ; Beck, G. ; Dawson, David L ; Billica, R. D. ; Johnston, S. L. ; Hamilton, D. R. / Percutaneous aspiration of fluid for management of peritonitis in space. In: Aviation Space and Environmental Medicine. 2002 ; Vol. 73, No. 9. pp. 925-930.
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abstract = "Background: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a {"}rescue{"} strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. Methods: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. Results: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. Conclusions: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the {"}rescue{"} of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.",
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N2 - Background: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. Methods: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. Results: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. Conclusions: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.

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