PEEP zero. Is this the answer?

22 Lug

Permissive HypoVENTilation for haemorrhagic shock?? http://t.co/AGCnddQzSs pic.twitter.com/txoAeZ0vUs

— Karim Brohi (@karimbrohi) July 21, 2014

Inspiring discussion on Twitter (Minh Le Cong@rfdsdoc, Karim Brohi @karimbrohi and Peter Sherren@PBSherren)

The topic:

Your hypotensive blunt/penetrating trauma patient with associated severe TBI needs a vent. How do you set it and how you achive your physiological goals?

Is it possible to mantain eucapnia, avoiding hypercapnic insult to the brain, using low minute ventilation strategy and not depressing stroke volume with high intrathoracic pressure?

“Permissive hypoventilation” in a swine model of hemorrhagic shock.

Conclusions: Although permissive hypoventilation leads to respiratory acidosis, it results in less hemodynamic suppression and better perfusion of vital organs. In severely injured penetrating trauma patients, consideration should be given to immediate transportation without PPV.

But what if we have concomitant severe TBI? How can we avoid respiratory acidosis and hypercapnia (due to hypoventilation) and conseguent insult to the brain?

Is PEEP zero the answer?

Influence of ventilation strategies on survival in severe controlled hemorrhagic shock.

Conclusions: In this porcine model of severe hemorrhagic shock, reduction of positive end-expiratory pressure was the most important ventilation strategy component influencing hemodynamic stability. Reducing mean airway pressure by decreasing tidal volumes and increasing respiratory rates seemed to have less influence on cardiopulmonary function and survival than 0 cm H2O positive end-expiratory pressure.

Influence of positive end-expiratory pressure ventilation on survival during severe hemorrhagic shock.

Conclusions: 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.

According to this swine model studies PEEP zero during severe hemorrhagic shock had significantly improved survival.

Bottom Line

Low MV (RR 8 TV 6 ml/kg IBW)
Zero PEEP
Target SaO2 to 95% (higher Fi O2 to achieve the target)
Target EtCO2 to 35-40 mmHg

Can it be our default setting on the hypotensive blunt/pentr trauma patient with sevre TBI?

Leave your comments and references.

Commenti Lascia un commento
Categorie Commenti dell'autore

Rispondi Cancella risposta

Scrivi qui il tuo commento...

Inserisci i tuoi dati qui sotto o clicca su un'icona per effettuare l'accesso:

E-mail (obbligatorio) (L'indirizzo non verrà pubblicato)

Nome (obbligatorio)

Sito web

Stai commentando usando il tuo account WordPress.com. ( Chiudi sessione / Modifica )

Stai commentando usando il tuo account Twitter. ( Chiudi sessione / Modifica )

Stai commentando usando il tuo account Facebook. ( Chiudi sessione / Modifica )

Annulla

Connessione a %s...

Questo sito utilizza Akismet per ridurre lo spam. Scopri come vengono elaborati i dati derivati dai commenti.

Ricerca

PEEP zero. Is this the answer?

Inspiring discussion on Twitter (Minh Le Cong@rfdsdoc, Karim Brohi @karimbrohi and Peter Sherren@PBSherren)

The topic:

Your hypotensive blunt/penetrating trauma patient with associated severe TBI needs a vent. How do you set it and how you achive your physiological goals?

Is it possible to mantain eucapnia, avoiding hypercapnic insult to the brain, using low minute ventilation strategy and not depressing stroke volume with high intrathoracic pressure?

“Permissive hypoventilation” in a swine model of hemorrhagic shock.

But what if we have concomitant severe TBI? How can we avoid respiratory acidosis and hypercapnia (due to hypoventilation) and conseguent insult to the brain?

Is PEEP zero the answer?

Influence of ventilation strategies on survival in severe controlled hemorrhagic shock.

Influence of positive end-expiratory pressure ventilation on survival during severe hemorrhagic shock.

According to this swine model studies PEEP zero during severe hemorrhagic shock had significantly improved survival.

Bottom Line

Low MV (RR 8 TV 6 ml/kg IBW)

Zero PEEP

Target SaO2 to 95% (higher Fi O2 to achieve the target)

Target EtCO2 to 35-40 mmHg

Can it be our default setting on the hypotensive blunt/pentr trauma patient with sevre TBI?

Leave your comments and references.

Rispondi Cancella risposta

Follow MEDEST via Email/Segui MEDEST via Email

Follow MEDEST on Facebook

Follow MEDEST on Twitter

Articoli recenti

The MEDEST on line News

Archivi

MyTweet

Favourites FOAMED Blogs

Scrivi a MEDEST

Ricerca

PEEP zero. Is this the answer?

Inspiring discussion on Twitter (Minh Le Cong@rfdsdoc, Karim Brohi @karimbrohi and Peter Sherren@PBSherren)

The topic:

Your hypotensive blunt/penetrating trauma patient with associated severe TBI needs a vent. How do you set it and how you achive your physiological goals?

Is it possible to mantain eucapnia, avoiding hypercapnic insult to the brain, using low minute ventilation strategy and not depressing stroke volume with high intrathoracic pressure?

“Permissive hypoventilation” in a swine model of hemorrhagic shock.

But what if we have concomitant severe TBI? How can we avoid respiratory acidosis and hypercapnia (due to hypoventilation) and conseguent insult to the brain?

Is PEEP zero the answer?

Influence of ventilation strategies on survival in severe controlled hemorrhagic shock.

Influence of positive end-expiratory pressure ventilation on survival during severe hemorrhagic shock.

According to this swine model studies PEEP zero during severe hemorrhagic shock had significantly improved survival.

Bottom Line

Low MV (RR 8 TV 6 ml/kg IBW)

Zero PEEP

Target SaO2 to 95% (higher Fi O2 to achieve the target)

Target EtCO2 to 35-40 mmHg

Can it be our default setting on the hypotensive blunt/pentr trauma patient with sevre TBI?

Leave your comments and references.

Condividi:

Mi piace:

Correlati

Rispondi Cancella risposta

Follow MEDEST via Email/Segui MEDEST via Email

Follow MEDEST on Facebook

Follow MEDEST on Twitter

Articoli recenti

The MEDEST on line News

Archivi

MyTweet

Favourites FOAMED Blogs

Scrivi a MEDEST