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 Scopus citations

Abstract

Methods:Eight swine (ventilated with 12 mL/kg tidal volume, 0.28 FIOSB; 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).

Original languageEnglish (US)
Pages (from-to)1048-1057
Number of pages10
JournalJournal of Trauma
Volume54
Issue number6
DOIs
StatePublished - Jun 2003

    Fingerprint

Keywords

  • Auto-positive end-expiratory pressure
  • Cardiac arrest
  • 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
  • Critical Care and Intensive Care Medicine

Cite this

Pepe, P. E., Raedler, C., Lurie, K. G., Wigginton, J. G., Brasel, K. J., Hopkins, R. W., Beilman, G., Wall, M. J., & Dries, D. J. (2003). Emergency ventilatory management in hemorrhagic states: Elemental or Detrimental? Journal of Trauma, 54(6), 1048-1057. https://doi.org/10.1097/01.TA.0000064280.05372.7C