Document Detail

Influence of positive end-expiratory pressure ventilation on survival during severe hemorrhagic shock.
MedLine Citation:
PMID:  16187467     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: Although a moderate positive end-expiratory pressure (PEEP) level is widely recommended, it is unknown whether moderate PEEP during mechanical ventilation has adverse effects during severe hemorrhagic shock. Therefore, the purpose of our study was to evaluate the effects of 0 cm H2O PEEP versus 5 cm H2O PEEP versus 10 cm H2O PEEP on short-term survival in a porcine model of severe hemorrhagic shock. Secondary study endpoints were hemodynamic variables and blood gases. METHODS: Twenty-four anesthetized pigs were bled approximately 45 mL/kg, randomized into 3 groups, and then ventilated with 0, 5, or 10 cm H2O PEEP. Survival rates were compared using Kaplan-Meier methods with log rank (Mantel Cox) comparison of cumulative survival by treatment group. RESULTS: Seven of 8 0 cm H2O PEEP animals survived the 120-minute study period, but 8 of 8 5 cm H2O PEEP animals died within 30 minutes, and 8 of 8 10 cm H2O PEEP animals were dead within 20 minutes (P<.0001). Ventilation with 0 cm H2O PEEP prevented a further reduction of mean arterial blood pressure and cardiac output. When compared with the 0 cm H2O PEEP group, end-tidal CO2 declined in the 5 cm H2O PEEP and 10 cm H2O PEEP animals. Compared with the 0 cm H2O PEEP animals, those ventilated with 5 or 10 cm H2O PEEP had higher lactate levels after 10 minutes. CONCLUSION: When compared with pigs ventilated with either 5 or 10 cm H2O PEEP, those ventilated with 0 cm H2O PEEP during untreated, severe hemorrhagic shock had significantly improved short-term survival.
Anette C Krismer; Volker Wenzel; Karl H Lindner; Christopher W Haslinger; Stephan Oroszy; Karl H Stadlbauer; Alfred Königsrainer; Brian Boville; Christoph Hörmann
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  46     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-27     Completed Date:  2006-01-31     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  337-42     Citation Subset:  AIM; IM    
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
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MeSH Terms
Blood Gas Analysis
Disease Models, Animal
Emergency Medicine / methods
Positive-Pressure Respiration / methods*
Random Allocation
Shock, Hemorrhagic / blood,  physiopathology,  therapy*
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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