TY - JOUR
T1 - Cerebral oxygenation during hemorrhagic shock
T2 - Perils of hyperventilation and the therapeutic potential of hypoventilation
AU - Manley, Geoffrey T.
AU - Hemphill, J. Claude
AU - Morabito, Diane
AU - Derugin, Nikita
AU - Erickson, Vanessa
AU - Pitts, Lawrence H.
AU - Knudson, M. Margaret
PY - 2000/6
Y1 - 2000/6
N2 - Objectives: Prophylactic hyperventilation of patients with head injuries worsens outcome, presumably by exacerbating tissue hypoxia. Oxygen tension in brain tissue (P(br)O2) provides a direct measurement of cerebral metabolic substrate delivery and varies with changing end-tidal carbon dioxide tension (ETCO2) and mean arterial pressure. However, the effects of hyperventilation and hypoventilation on P(br)O2 during hemorrhagic shock are not known. The aim of this study was to examine the effects of alteration in ventilation on P(br)O2 in hemorrhaged swine. Methods: Clark-type polarographic probes were inserted into the brain tissue of seven swine to measure P(br)O2 directly. To examine the effects of alterations in ventilation on hemorrhage-induced hypotension, swine were hemorrhaged to 50% estimated blood volume and P(br)O2 was monitored during hyperventilation (RR = 30) and hypoventilation (RR = 4). Results: After the 50% hemorrhage, P(br)O2 declined rapidly from 39.8 ± 4.6 mm Hg to 11.4 ± 2.2 mm Hg. Hyperventilation resulted in a further 56% mean decrease in P(br)O2. Hypoventilation produced a 166% mean increase in P(br)O2. These changes were significant (p = 0.001) for absolute and percentage differences from baseline. Conclusion: During hemorrhage, alterations in ventilation significantly changed P(br)O2: hyperventilation increased brain-tissue hypoxia whereas hypoventilation alleviated it. This finding suggests that hyperventilation has deleterious effects on brain oxygenation in patients with hemorrhagic shock and those with head trauma. Conversely, hypoventilation with resultant hypercapnia may actually help resolve hemorrhagic shock-induced cerebral hypoxia.
AB - Objectives: Prophylactic hyperventilation of patients with head injuries worsens outcome, presumably by exacerbating tissue hypoxia. Oxygen tension in brain tissue (P(br)O2) provides a direct measurement of cerebral metabolic substrate delivery and varies with changing end-tidal carbon dioxide tension (ETCO2) and mean arterial pressure. However, the effects of hyperventilation and hypoventilation on P(br)O2 during hemorrhagic shock are not known. The aim of this study was to examine the effects of alteration in ventilation on P(br)O2 in hemorrhaged swine. Methods: Clark-type polarographic probes were inserted into the brain tissue of seven swine to measure P(br)O2 directly. To examine the effects of alterations in ventilation on hemorrhage-induced hypotension, swine were hemorrhaged to 50% estimated blood volume and P(br)O2 was monitored during hyperventilation (RR = 30) and hypoventilation (RR = 4). Results: After the 50% hemorrhage, P(br)O2 declined rapidly from 39.8 ± 4.6 mm Hg to 11.4 ± 2.2 mm Hg. Hyperventilation resulted in a further 56% mean decrease in P(br)O2. Hypoventilation produced a 166% mean increase in P(br)O2. These changes were significant (p = 0.001) for absolute and percentage differences from baseline. Conclusion: During hemorrhage, alterations in ventilation significantly changed P(br)O2: hyperventilation increased brain-tissue hypoxia whereas hypoventilation alleviated it. This finding suggests that hyperventilation has deleterious effects on brain oxygenation in patients with hemorrhagic shock and those with head trauma. Conversely, hypoventilation with resultant hypercapnia may actually help resolve hemorrhagic shock-induced cerebral hypoxia.
KW - Cerebral oxygenation
KW - Cerebral resuscitation
KW - Hemorrhage
KW - Hyperventilation
KW - Hypoventilation
UR - http://www.scopus.com/inward/record.url?scp=0033936841&partnerID=8YFLogxK
U2 - 10.1097/00005373-200006000-00005
DO - 10.1097/00005373-200006000-00005
M3 - Article
C2 - 10866246
AN - SCOPUS:0033936841
SN - 0022-5282
VL - 48
SP - 1025
EP - 1033
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 6
ER -