Journal ArticleDOI
"Permissive hypoventilation" in a swine model of hemorrhagic shock.
Sharven Taghavi,Senthil N. Jayarajan,Lucas M. Ferrer,Halley Vora,Conor McKee,Richard Milner,John P. Gaughan,Jay Dujon,Lars O. Sjoholm,Abhijit Pathak,Joseph F. Rappold,Thomas A. Santora,Steven R. Houser,Amy J. Goldberg +13 more
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TLDR
Although permissive hypoventilation leads to respiratory acidosis, it results in less hemodynamic suppression and better perfusion of vital organs in severely injured penetrating trauma patients and should be given to immediate transportation without PPV.Abstract:
BACKGROUND Many penetrating trauma patients in severe hemorrhagic shock receive positive pressure ventilation (PPV) upon transport to definitive care, either by intubation (INT) or bag-valve mask (BVM). Using a swine hemorrhagic shock model that simulates penetrating trauma, we proposed that severely injured patients may have better outcomes with "permissive hypoventilation," where manual breaths are not given and oxygen is administrated passively via face mask (FM). We hypothesized that PPV has harmful physiologic effects in severe low-flow states and that permissive hypoventilation would result in better outcomes. METHODS The carotid arteries of Yorkshire pigs were cannulated with a 14-gauge catheter. One group of animals (n = 6) was intubated and manually ventilated, a second received PPV via BVM (n = 7), and a third group received 100% oxygen via FM (n = 6). After placement of a Swan-Ganz catheter, the carotid catheters were opened, and the animals were exsanguinated. The primary end point was time until death. Secondary end points included central venous pressure, cardiac output, lactate levels, serum creatinine, CO2 levels, and pH measured in 10-minute intervals. RESULTS Average survival time in the FM group (50.0 minutes) was not different from the INT (51.1 minutes) and BVM groups (48.5 minutes) (p = 0.84). Central venous pressure was higher in the FM group as compared with the INT 10 minutes into the shock phase (8.3 mm Hg vs. 5.2 mm Hg, p = 0.04). Drop in cardiac output (p < 0.001) and increase in lactate (p < 0.05) was worse in both PPV groups throughout the shock phase. Creatinine levels were higher in both PPV groups (p = 0.04). The FM group was more hypercarbic and acidotic than the two PPV groups during the shock phase (p < 0.001). CONCLUSION Although permissive hypoventilation leads to respiratory acidosis, it results in less hemodynamic suppression and better perfusion of vital organs. In severely injured penetrating trauma patients, consideration should be given to immediate transportation without PPV.read more
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Journal ArticleDOI
Permissive hypercapnia: what to remember.
TL;DR: This review will present data from recent studies relating to hypercapnia, focusing on issues that are of importance to anesthesiologists caring for the surgical and/or critically ill patient.
Journal ArticleDOI
Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients
TL;DR: Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups, and ISS, GCS, and age were found to be independent predictors of in-hospital mortality.
Journal ArticleDOI
Field intubation in civilian patients with hemorrhagic shock is associated with higher mortality.
Daisy Chou,Megan Y. Harada,Galinos Barmparas,Ara Ko,Eric J. Ley,Daniel R. Margulies,Rodrigo F. Alban +6 more
TL;DR: FI may be associated with higher mortality in trauma patients with hemorrhagic shock requiring massive transfusion and less invasive airway interventions and rapid transport might improve outcomes for these patients.
Journal ArticleDOI
Airway and ventilation management strategies for hemorrhagic shock. To tube, or not to tube, that is the question!
TL;DR: It is suggested that for patients with hemorrhagic shock who do not have a compromised airway and who are able to maintain adequate oxygen saturation (or mentation if monitoring is unreliable), a strategy of delayed intubation should be strongly encouraged.
Journal ArticleDOI
An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients.
Sharven Taghavi,Zoe Maher,Amy J. Goldberg,Grace Chang,Michelle Mendiola,Christofer Anderson,Scott Ninokawa,Leah C. Tatebe,Patrick Maluso,Shariq S. Raza,Jane Keating,Sigrid Burruss,Matthew E. Reeves,Lauren E. Coleman,David V. Shatz,Anna Goldenberg-Sandau,Apoorva Bhupathi,M Chance Spalding,Aimee K. Lariccia,Emily Bird,Matthew R. Noorbakhsh,James Babowice,Marsha C. Nelson,Lewis E. Jacobson,Jamie Williams,Michael Vella,Kate Dellonte,Thomas Z. Hayward,Emma Holler,Mark Lieser,John D. Berne,Dalier Rodriguez Mederos,Reza Askari,Barbara U. Okafor,Elliott R. Haut,Eric Etchill,Raymond Fang,Samantha L. Roche,Laura Whittenburg,Andrew C. Bernard,James M. Haan,Kelly L. Lightwine,Scott H. Norwood,Jason Murry,Mark A. Gamber,Matthew M. Carrick,Nikolay Bugaev,Antony Tatar,Juan Duchesne,Danielle Tatum +49 more
TL;DR: Taghavi et al. as discussed by the authors examined the influence of prehospital procedures (PHP) on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged.
References
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Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation
Tom P. Aufderheide,Gardar Sigurdsson,Ronald G. Pirrallo,Demetris Yannopoulos,Scott McKnite,Chris von Briesen,Christopher W. Sparks,Craig J. Conrad,Terry A Provo,Keith G. Lurie +9 more
TL;DR: Subsequent animal studies demonstrated that similar excessive ventilation rates resulted in significantly increased intrathoracic pressure and markedly decreased coronary perfusion pressures and survival rates.
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Effect of Out-of-Hospital Pediatric Endotracheal Intubation on Survival and Neurological Outcome: A Controlled Clinical Trial
Marianne Gausche,Roger J. Lewis,Samuel J. Stratton,Bruce E. Haynes,Carol S. Gunter,Suzanne M. Goodrich,Pamela D. Poore,Maureen McCollough,Deborah Parkman Henderson,Franklin D. Pratt,James S. Seidel +10 more
TL;DR: The addition of out-of-hospital ETI to a paramedic scope of practice that already includes BVM did not improve survival or neurological outcome of pediatric patients treated in an urban EMS system.
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Physiological studies of the effects of intermittent positive pressure breathing on cardiac output in man
TL;DR: Three types of positive pressure breathing have been differentiated and only the latter type of pressure breathing (IPPB) is suitable for maintaining artificial respiration in the apneic subject.
Journal ArticleDOI
Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.
TL;DR: An inversely proportional relationship between mean intratracheal pressure and coronary perfusion pressure during CPR is demonstrated, demonstrating that professional rescuers consistently hyperventilated patients during out-of-hospital CPR.
Journal ArticleDOI
Continuous Positive-Pressure Ventilation in Acute Respiratory Failure
Anil Kumar,K. J. Falke,Bennie Geffin,Carolyn F. Aldredge,Myron B. Laver,Edward Lowenstein,Henning Pontoppidan +6 more
TL;DR: In this paper, continuous positive pressure ventilation was used in eight patients with severe acute respiratory failure to improve their lung function and the mean end-expiratory pressure and lung function.