Emergency ventilatory management in hemorrhagic states

Elemental or detrimental?

Paul E. Pepe, Claus Raedler, Keith G. Lurie, Jane G. Wigginton, Karen J. Brasel, Robert W. Hopkins, Gregory Beilman, Matthew J. Wall, David J. Dries

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: A study was performed to demonstrate that slower respiratory rates (RRs) of positive-pressure ventilation can preserve adequate oxygenation and acid-base status in hemorrhagic states, whereas "normal" or higher RRs worsen hemodynamics. Methods: Eight swine (ventilated with 12 mL/kg tidal volume, 0.28 F1O2; RR of 12 breaths/min) were hemorrhaged to < 65 mm Hg systolic arterial blood pressure (SABP). RRs were then sequentially changed every 10 minutes to 6, 20, 30, and 6 breaths/min. Results: With RRs at 6 breaths/min, the animals maintained pH > 7.25/SaO2 > 99%, but increased mean SABP (from 65 to 84 mm Hg; p < 0.05), time-averaged coronary perfusion pressure (CPP) (from 50 ± 2 to 60 ± 4 mm Hg; p < 0.05), and cardiac output (Qt) (from 2.4 to 2.8 L/min; p < 0.05). With RRs of 20 and 30 breaths/min, SABP (73 and 66 mm Hg), CPP (47 ± 3 and 42 ± 4 mm Hg), and Qt (2.5 and 2.4 L/min) decreased, as did PaO2 and PaCO2 (< 30 mm Hg), with p < 0.05 for each comparison, respectively. When RR returned to 6 breaths/min, SABP (95 mm Hg), CPP (71 ± 6 mm Hg), and Qt (3.0 L/min) improved significantly (p < 0.05). Conclusion: After even moderate levels of hemorrhage in animals, positive-pressure ventilation with "normal" or higher RRs can impair hemodynamics. Hemodynamics can be improved with lower RRs while still maintaining adequate oxygenation and ventilation.

Original languageEnglish (US)
Pages (from-to)1048-1057
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number6
StatePublished - Jun 1 2003

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Respiratory Rate
Emergencies
Positive-Pressure Respiration
Perfusion
Hemodynamics
Pressure
Tidal Volume
Cardiac Output
Ventilation
Swine
Hemorrhage
Acids

Keywords

  • Auto-positive end-expiratory pressure
  • Coronary perfusion pressure
  • Hemodynamics
  • Hemorrhage
  • Hemorrhagic shock
  • Hypovolemia
  • Mechanical ventilation
  • Positive-pressure ventilation
  • Preload
  • Respiratory support
  • Resuscitation
  • Shock
  • Venous return
  • Ventilation

ASJC Scopus subject areas

  • Surgery

Cite this

Emergency ventilatory management in hemorrhagic states : Elemental or detrimental? / Pepe, Paul E.; Raedler, Claus; Lurie, Keith G.; Wigginton, Jane G.; Brasel, Karen J.; Hopkins, Robert W.; Beilman, Gregory; Wall, Matthew J.; Dries, David J.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 54, No. 6, 01.06.2003, p. 1048-1057.

Research output: Contribution to journalArticle

Pepe, PE, Raedler, C, Lurie, KG, Wigginton, JG, Brasel, KJ, Hopkins, RW, Beilman, G, Wall, MJ & Dries, DJ 2003, 'Emergency ventilatory management in hemorrhagic states: Elemental or detrimental?', Journal of Trauma - Injury, Infection and Critical Care, vol. 54, no. 6, pp. 1048-1057.
Pepe, Paul E. ; Raedler, Claus ; Lurie, Keith G. ; Wigginton, Jane G. ; Brasel, Karen J. ; Hopkins, Robert W. ; Beilman, Gregory ; Wall, Matthew J. ; Dries, David J. / Emergency ventilatory management in hemorrhagic states : Elemental or detrimental?. In: Journal of Trauma - Injury, Infection and Critical Care. 2003 ; Vol. 54, No. 6. pp. 1048-1057.
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abstract = "Background: A study was performed to demonstrate that slower respiratory rates (RRs) of positive-pressure ventilation can preserve adequate oxygenation and acid-base status in hemorrhagic states, whereas {"}normal{"} or higher RRs worsen hemodynamics. Methods: Eight swine (ventilated with 12 mL/kg tidal volume, 0.28 F1O2; RR of 12 breaths/min) were hemorrhaged to < 65 mm Hg systolic arterial blood pressure (SABP). RRs were then sequentially changed every 10 minutes to 6, 20, 30, and 6 breaths/min. Results: With RRs at 6 breaths/min, the animals maintained pH > 7.25/SaO2 > 99{\%}, but increased mean SABP (from 65 to 84 mm Hg; p < 0.05), time-averaged coronary perfusion pressure (CPP) (from 50 ± 2 to 60 ± 4 mm Hg; p < 0.05), and cardiac output (Qt) (from 2.4 to 2.8 L/min; p < 0.05). With RRs of 20 and 30 breaths/min, SABP (73 and 66 mm Hg), CPP (47 ± 3 and 42 ± 4 mm Hg), and Qt (2.5 and 2.4 L/min) decreased, as did PaO2 and PaCO2 (< 30 mm Hg), with p < 0.05 for each comparison, respectively. When RR returned to 6 breaths/min, SABP (95 mm Hg), CPP (71 ± 6 mm Hg), and Qt (3.0 L/min) improved significantly (p < 0.05). Conclusion: After even moderate levels of hemorrhage in animals, positive-pressure ventilation with {"}normal{"} or higher RRs can impair hemodynamics. Hemodynamics can be improved with lower RRs while still maintaining adequate oxygenation and ventilation.",
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T1 - Emergency ventilatory management in hemorrhagic states

T2 - Elemental or detrimental?

AU - Pepe, Paul E.

AU - Raedler, Claus

AU - Lurie, Keith G.

AU - Wigginton, Jane G.

AU - Brasel, Karen J.

AU - Hopkins, Robert W.

AU - Beilman, Gregory

AU - Wall, Matthew J.

AU - Dries, David J.

PY - 2003/6/1

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N2 - Background: A study was performed to demonstrate that slower respiratory rates (RRs) of positive-pressure ventilation can preserve adequate oxygenation and acid-base status in hemorrhagic states, whereas "normal" or higher RRs worsen hemodynamics. Methods: Eight swine (ventilated with 12 mL/kg tidal volume, 0.28 F1O2; RR of 12 breaths/min) were hemorrhaged to < 65 mm Hg systolic arterial blood pressure (SABP). RRs were then sequentially changed every 10 minutes to 6, 20, 30, and 6 breaths/min. Results: With RRs at 6 breaths/min, the animals maintained pH > 7.25/SaO2 > 99%, but increased mean SABP (from 65 to 84 mm Hg; p < 0.05), time-averaged coronary perfusion pressure (CPP) (from 50 ± 2 to 60 ± 4 mm Hg; p < 0.05), and cardiac output (Qt) (from 2.4 to 2.8 L/min; p < 0.05). With RRs of 20 and 30 breaths/min, SABP (73 and 66 mm Hg), CPP (47 ± 3 and 42 ± 4 mm Hg), and Qt (2.5 and 2.4 L/min) decreased, as did PaO2 and PaCO2 (< 30 mm Hg), with p < 0.05 for each comparison, respectively. When RR returned to 6 breaths/min, SABP (95 mm Hg), CPP (71 ± 6 mm Hg), and Qt (3.0 L/min) improved significantly (p < 0.05). Conclusion: After even moderate levels of hemorrhage in animals, positive-pressure ventilation with "normal" or higher RRs can impair hemodynamics. Hemodynamics can be improved with lower RRs while still maintaining adequate oxygenation and ventilation.

AB - Background: A study was performed to demonstrate that slower respiratory rates (RRs) of positive-pressure ventilation can preserve adequate oxygenation and acid-base status in hemorrhagic states, whereas "normal" or higher RRs worsen hemodynamics. Methods: Eight swine (ventilated with 12 mL/kg tidal volume, 0.28 F1O2; RR of 12 breaths/min) were hemorrhaged to < 65 mm Hg systolic arterial blood pressure (SABP). RRs were then sequentially changed every 10 minutes to 6, 20, 30, and 6 breaths/min. Results: With RRs at 6 breaths/min, the animals maintained pH > 7.25/SaO2 > 99%, but increased mean SABP (from 65 to 84 mm Hg; p < 0.05), time-averaged coronary perfusion pressure (CPP) (from 50 ± 2 to 60 ± 4 mm Hg; p < 0.05), and cardiac output (Qt) (from 2.4 to 2.8 L/min; p < 0.05). With RRs of 20 and 30 breaths/min, SABP (73 and 66 mm Hg), CPP (47 ± 3 and 42 ± 4 mm Hg), and Qt (2.5 and 2.4 L/min) decreased, as did PaO2 and PaCO2 (< 30 mm Hg), with p < 0.05 for each comparison, respectively. When RR returned to 6 breaths/min, SABP (95 mm Hg), CPP (71 ± 6 mm Hg), and Qt (3.0 L/min) improved significantly (p < 0.05). Conclusion: After even moderate levels of hemorrhage in animals, positive-pressure ventilation with "normal" or higher RRs can impair hemodynamics. Hemodynamics can be improved with lower RRs while still maintaining adequate oxygenation and ventilation.

KW - Auto-positive end-expiratory pressure

KW - Coronary perfusion pressure

KW - Hemodynamics

KW - Hemorrhage

KW - Hemorrhagic shock

KW - Hypovolemia

KW - Mechanical ventilation

KW - Positive-pressure ventilation

KW - Preload

KW - Respiratory support

KW - Resuscitation

KW - Shock

KW - Venous return

KW - Ventilation

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VL - 54

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JO - Journal of Trauma and Acute Care Surgery

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