Bilateral vagotomy inhibits apnea and attenuates other physiological responses after blunt chest trauma.
BACKGROUND
Behind armor blunt trauma (BABT) is defined as the nonpenetrating injury resulting from a ballistic impact on body armor. Some of the kinetic energy is transferred to the body, causing internal injuries and, occasionally, death. The aim of this study was to investigate if apnea and other pathophysiological effects after BABT is a vagally mediated reflex.


METHODS
Sixteen anesthetized pigs wearing body armor, of which five were vagotomized, were shot with a standard 7.62 mm assault rifle. These animals were compared with control animals (n = 8), shot with blank ammunition. We performed bilateral vagotomy before the shot and assessed the outcome on the apnea period, respiration, circulation, and brain function. Animals were monitored during a 2-hour period after the shot.


RESULTS
Nonvagotomized animals had a mean apnea period of 22 (6-44) seconds. This group also showed a significant decrease in oxygen saturation compared with control animals. Furthermore, electroencephalogram-changes were more pronounced in nonvagotomized animals. In contrast, vagotomized animals were protected from apnea and showed only a minor decrease in oxygen saturation. All exposed animals showed impaired circulation, and postmortem examination revealed a pulmonary contusion.


CONCLUSIONS
This study shows that apnea after BABT is a vagally mediated reflex that can be inhibited by bilateral vagotomy. Our results indicate that the initial apnea period is an important factor for hypoxia after BABT. Supported ventilation should begin immediately if the affected person is unconscious and suffers from apnea. It should continue until the neurologic paralysis disappears and sufficient spontaneous breathing begins.
Department of Clinical Science and Education, Karolinska Institute at Söder Hospital, Stockholm, Sweden.
Dan
D
Gryth
David
D
Rocksén
Ulf P
UP
Arborelius
Dan
D
Drobin
Jonas K E
JK
Persson
Anders
A
Sondén
Jenny
J
Bursell
Lars-Gunnar
LG
Olsson
B Thomas
BT
Kjellström
D000818:Animals; D001049:Apnea / Q000209:etiology / Q000517:prevention & control*; D001919:Bradycardia / Q000209:etiology / Q000517:prevention & control; D016001:Confidence Intervals; D004195:Disease Models, Animal; D004569:Electroencephalography; D044709:Forensic Ballistics; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D011336:Probability; D011897:Random Allocation; D012016:Reference Values; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D018570:Risk Assessment; D012774:Shock, Traumatic / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate; D013552:Swine; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery*