title: Detrimental hemodynamic effects of assisted ventilation in hemorrhagic states.
abstract: OBJECTIVE
  Our goal was to demonstrate explicitly that lower-frequency positive-pressure ventilation not only preserves adequate oxygenation and acid-base status in hemorrhagic states, but also that "normal" or higher respiratory rates significantly compromise hemodynamics, even with moderate degrees of hemorrhage.
  
  
  METHODS
  Eight intubated pigs (ventilated with 12 mL/kg tidal volume, 28% FIO2, respiratory rate = 12 breaths/min) were hemorrhaged to <65 mm Hg of systolic blood pressure. Respiratory rates were then sequentially changed every 10 mins to 6, 20, 30, and 6 breaths/min.
  
  
  RESULTS
  With respiratory rates at 6 breaths/min, all subjects maintained pH of >7.25 and SaO2 of >99% while increasing systolic blood pressure (mean, 65-84 mm Hg; p < .05), time-averaged coronary perfusion pressure (50 +/- 2 to 60 +/- 4 mm Hg; p < .05), and cardiac output (2.4 to 2.8 L/min; p < .05). With respiratory rates of 20 and 30 breaths/min, systolic blood pressure (73 +/- 4 and 66 +/- 5 mm Hg, respectively), coronary perfusion pressure (47 +/- 3 and 42 +/- 4 mm Hg), and cardiac output (2.5 and 2.4 L/min) diminished. When returned to 6 breaths/min, systolic blood pressure (95 mm Hg), coronary perfusion pressure (71 + 6 mm Hg), and cardiac output (3.0 L/min) improved significantly (p < .05 for all comparisons).
  
  
  CONCLUSIONS
  After moderate hemorrhage, animals maintain adequate oxygenation and acid-base status with lower-frequency respiratory rates, whereas increasingly higher respiratory rates progressively and significantly impair hemodynamics. Current ventilatory protocols for trauma resuscitation should be re-examined and considered a possible cause of worsened clinical outcomes and unrecognized confounded study results.
authors.affiliation: Department of Surgery, and the School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Pepe
authors.forename: Keith G
authors.initials: KG
authors.lastname: Lurie
authors.forename: Jane G
authors.initials: JG
authors.lastname: Wigginton
authors.forename: Claus
authors.initials: C
authors.lastname: Raedler
authors.forename: Ahamed H
authors.initials: AH
authors.lastname: Idris
mesh_terms: D000818:Animals; D001794:Blood Pressure; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D012119:Respiration; D013552:Swine