Risk of Harm Associated With Using Rapid Sequence Induction Intubation and Positive Pressure Ventilation in Patients With Hemorrhagic Shock

Thompson, Patrick; Hudson, Anthony; Convertino, Victor A.; Bjerkvig, Christopher; Eliassen, Håkon Skogrand; Eastridge, Brian J.; Irvine-Smith, Timm; Braverman, Maxwell A.; Hellander, Stefan; Jenkins, Donald H.; Rappold, Joseph F.; Gurney, Jennifer M; Glassberg, Elon; Andrew, P; Aussett, Sylviain; Apelseth, Torunn Oveland; Williams, Steve; Ward, Kevin R.; Shackelford, Stacy; Stroberg, Pierre; Vikeness, Bjarne H; Pepe, Paul E.; Winckler, C; Woolley, Tom; Enbuske, Stefan; Pasquale, Marc De; Boffard, Kenneth D.; Austlid, Ivar; Fosse, Theodore K; Asbjørnsen, Helge; Spinella, Philip C.; Strandenes, Geir

doi:10.55460/q4g3-feqr

Cited by 3 publications

(6 citation statements)

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“…9 This would allow for the prioritization of whole blood infusion, which would save time and mitigate the physiologic effects of a subsequent rapid sequence induction and positive pressure ventilation. 8 In addition, permissive hypoventilation may increase blood pressure by maintaining negative intrathoracic pressure and increasing venous return to the heart. 8,9 An initial study showed that spontaneous ventilation in porcine hemorrhage increased cardiac output and decreased lactate compared with positive pressure ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, it has been proposed that tracheal intubation and positive pressure ventilation should not be used in patients with hemorrhagic shock. 8 However, the consequences of not intubating have not been fully investigated. It is possible that permissive hypoventilation, refraining from tracheal intubation and positive pressure ventilation and instead accepting spontaneous ventilation, may be preferable in severe hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

“…8 In addition, permissive hypoventilation may increase blood pressure by maintaining negative intrathoracic pressure and increasing venous return to the heart. 8,9 An initial study showed that spontaneous ventilation in porcine hemorrhage increased cardiac output and decreased lactate compared with positive pressure ventilation. 9 However, it is not known whether permissive hypoventilation maintains satisfactory oxygen delivery or improves hemodynamics after severe hemorrhage and resuscitation with whole blood.…”

Section: Introductionmentioning

confidence: 99%

“…These effects are particularly harmful after severe hemorrhage. For this reason, it has been proposed that tracheal intubation and positive pressure ventilation should not be used in patients with hemorrhagic shock 8 . However, the consequences of not intubating have not been fully investigated.…”

Section: Introductionmentioning

confidence: 99%

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Permissive hypoventilation equally effective to maintain oxygenation as positive pressure ventilation after porcine class III hemorrhage and whole blood resuscitation

et al. 2023

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Background Prehospital anesthesia may lead to circulatory collapse after severe hemorrhage. It is possible that permissive hypoventilation, refraining from tracheal intubation and accepting spontaneous ventilation, decreases this risk, but it is not known if oxygen delivery can be maintained. We investigated the feasibility of permissive hypoventilation after class III hemorrhage and whole blood resuscitation in three prehospital phases: 15 min on‐scene, 30 min whole blood resuscitation, and 45 min after. Study Design and Methods 19 crossbred swine, mean weight 58.5 kg, were anesthetized with ketamine/midazolam and hemorrhaged to a mean (SD) 1298 (220) mL (33%) and randomized to permissive hypoventilation (n = 9) or positive pressure ventilation with FiO2 21% (n = 10). Results In permissive hypoventilation versus positive pressure ventilation, indexed oxygen delivery (DO2I) decreased to mean (SD) 4.73 (1.06) versus 3.70 (1.13) mL min−1 kg−1 after hemorrhage and increased to 8.62 (2.09) versus 6.70 (1.56) mL min−1 kg−1 at completion of resuscitation. DO2I, indexed oxygen consumption (VO2I), and arterial saturation (SaO2) did not differ. Permissive hypoventilation increased the respiratory rate and increased pCO2. Positive pressure ventilation did not deteriorate circulation. Cardiac index (CI), systolic arterial pressure (SAP), hemoglobin (Hb), and heart rate did not differ. Discussion Permissive hypoventilation and positive pressure ventilation were equally effective to maintain oxygen delivery in all phases. A respiratory rate of 40 was feasible, showing no signs of respiratory fatigue for 90 min, indicating that whole blood resuscitation may be prioritized in select patients with severe hemorrhage and spontaneous breathing.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Permissive hypoventilation equally effective to maintain oxygenation as positive pressure ventilation after porcine class III hemorrhage and whole blood resuscitation

et al. 2023

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“…In a patient with shock, rapid sequence intubation or positive pressure ventilation increases the burden of shock due to decreased cardiac output and increasing oxygen debt leading to organ dysfunction and coagulopathy. 9 Hence hemodynamic compromise and cardiac arrest should be managed with fluid, blood, and vasopressor before induction and intubation. 10 That patient in hemorrhagic shock with intact airways and who can maintain adequate oxygenation strategy of delayed intubation should be strongly adviced.…”

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confidence: 99%

Prospective study of intubation after physiological optimization in the emergency department

Das

Chhantel²,

Shah³

et al. 2022

jgpeman

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Emergency departments witness all sorts of unprecedented types of patients with respiratory compromise. Airway management must be done expeditiously in dire situations. It’s a well-known fact that patients are not well optimized for intubation as soon as they land up in an emergency. There might have a myriad of comorbidities to be addressed. Amongst various, we have discussed intubation in patients with increased intracranial pressure, patients with shock, patients with acidosis, and patients with respiratory failure. To have a better understanding of the physiological status of patients, reviewed 18 articles, and retrieved a synopsis from the abstract and conclusion. Here we have discussed the physiological optimization of patients based on current recommendation.

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Ausbildung und Simulationstraining in Atemwegsmanagement und Notfallnarkose

Grübl,

Schroeder,

Eimer

et al. 2024

Notfall Rettungsmed

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Risk of Harm Associated With Using Rapid Sequence Induction Intubation and Positive Pressure Ventilation in Patients With Hemorrhagic Shock

Cited by 3 publications

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Permissive hypoventilation equally effective to maintain oxygenation as positive pressure ventilation after porcine class III hemorrhage and whole blood resuscitation

Permissive hypoventilation equally effective to maintain oxygenation as positive pressure ventilation after porcine class III hemorrhage and whole blood resuscitation

Prospective study of intubation after physiological optimization in the emergency department

Ausbildung und Simulationstraining in Atemwegsmanagement und Notfallnarkose

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