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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/TA.0000000000000278 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Hepatic artery pseudoaneurysm-the Mayo Clinic experience and literature review.
Front Med (Lausanne)
December 2024
Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States.
Introduction: Hepatic artery pseudoaneurysm (HAP) is a rare and potentially life-threatening condition associated with high mortality. This study aims to review the etiology, clinical manifestations, management, and outcomes of patients diagnosed and treated for HAP at the Mayo Clinic.
Methodology: This study was a retrospective chart review of medical records for patients diagnosed and treated for hepatic artery pseudoaneurysm (HAP) at the Mayo Clinic (Florida, Minnesota, and Arizona) between September 1, 1998, and June 30, 2022.
Arterio-Ureteral Fistula as a Long-term Complication Following Retroperitoneal Presacral Ganglioneuroma Resection: Case Report in an Adolescent and Review of the Literature.
European J Pediatr Surg Rep
January 2024
Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
Arterio-ureteral fistula (AUF) is a rare condition affecting nearby adult-only patients. Patients usually present with hematuria, often starting as intermittent hematuria which frequently increases, and may lead to hemorrhagic shock. Without rapid diagnosis and prompt treatment, AUF can be lethal.
View Article and Find Full Text PDFIL-1β primed mesenchymal stromal cells moderate hemorrhagic shock-induced vascular permeability.
J Transl Med
December 2024
Institut de Recherche Biomédicale Des Armées (IRBA), 1, Rue du Lieutenant Raoul Batany, 92141, Clamart, France.
Background: Hemorrhagic shock (HS) corresponds to absolute hypovolemia creating an imbalance between oxygen supply and consumption. This causes an impaired hemostasis, a systemic inflammatory response, and microvascular permeability which can lead to multiple organ failure (MOF). There is no specific treatment for the endothelial dysfunction that plays a major role in the evolution towards MOF.
View Article and Find Full Text PDFHybrid Endovascular and Direct Surgical Approach for Treatment of Penetrating Common Carotid Artery Injury: A Case Report.
NMC Case Rep J
December 2024
Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan.
Although rare, penetrating cervical vascular injury poses significant challenges with a poor patient prognosis, often attributed to severe hemorrhage and accompanying injuries. We encountered a case of hemorrhagic shock resulting from a penetrating injury to the common carotid artery (CCA), which was successfully managed using a combination of endovascular therapy and direct surgical intervention. A 23-year-old man presented with a self-inflicted stab wound on the left side of his neck from a kitchen knife.
View Article and Find Full Text PDFA New Hybrid Quantitative Evaluation Model for Axillary Junctional Hemorrhage in Swine.
J Vis Exp
December 2024
State Key Laboratory of Trauma, Burns and Combined Injuries, Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University;
In this study, we developed and validated a hybrid quantitative model for simulating upper extremity junctional hemorrhage in swine, aiming to advance the development of pre-hospital hemostatic products. Utilizing 12 healthy 8-month-old male Yorkshire swine, we demonstrated the feasibility of a swine axillary artery injury model for evaluating hemostatic efficacy. Animals were divided into three groups to undergo volume-controlled hemorrhage (VCH), mimicking Class I-III hemorrhagic shock by withdrawing blood at different rates.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!