Annals of Emergency Medicine
Volume 46, Issue 4 , Pages 337-342, October 2005

Influence of Positive End-Expiratory Pressure Ventilation on Survival During Severe Hemorrhagic Shock

From the Department of Anesthesiology and Critical Care Medicine (Krismer, Wenzel, Lindner, Haslinger, Oroszy, Stadlbauer, Hörmann), the Department of Surgery (Königsrainer), Innsbruck Medical University, Innsbruck, Austria; and the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA (Boville)

Received 7 May 2004; received in revised form 13 August 2004 and 18 January 2005; accepted 9 February 2005. published online 03 May 2005.

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.

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 Supervising editor: Stephen R. Thom, MD, PhDAuthor contributions: ACK, VW, and KHL conceived the study, designed the trial, and obtained research funding. AK and CH supervised the conduct of the trial and data collection. CWH, SO, and BB performed the experiments and collected the data. KHS provided statistical advice on study design and analyzed the data. ACK and VW drafted the manuscript, and all authors contributed substantially to its revision. ACK takes responsibility for the paper as a whole.Funding and support: Supported by the Austrian National Bank Grant 10618, Vienna, Austria; and the Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.Presented at the 76th Scientific Sessions 2003 of the American Heart Association, November 2003, Orlando, FL.Reprints not available from the authors.

PII: S0196-0644(05)00269-6

doi:10.1016/j.annemergmed.2005.02.022

Annals of Emergency Medicine
Volume 46, Issue 4 , Pages 337-342, October 2005

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