Airway and ventilation management strategies for haemorrhagic shock. To tube, or not to tube, that is the question!

2.50
Hdl Handle:
http://hdl.handle.net/11287/620619
Title:
Airway and ventilation management strategies for haemorrhagic shock. To tube, or not to tube, that is the question!
Authors:
Hudson, Anthony; Strandenes, G.; Bjerkvig, C. K.; Svanevik, M.; Glassberg, E.
Abstract:
Many standard trauma management guidelines advocate the early use of endotracheal intubation and positive pressure ventilation as key treatment interventions in haemorrhagic shock. The evidence for using these airway and ventilation strategies to manage a circulation problem is unclear. The potentially harmful effects of drug assisted intubation and positive pressure ventilation include reduced cardiac output, apnoea, hypoxia, hypocapnoea (due to inadvertent hyperventilation) and unnecessarily prolonged on-scene times. Conversely the beneficial effects of spontaneous, negative pressure ventilation upon cardiac output are well described. Few studies, however, have attempted to explore the potential advantages of a strategy of delayed intubation and ventilation (together with a policy of aggressive volume replacement) in shocked trauma patients. Given the lack of evidence, the decision making around how, when and where to subject shocked trauma patients to intubation and positive pressure ventilation remains complex. If providers choose to delay intubation they must have the appropriate skills to safely manage the airway and recognise the need for subsequent intervention. If they decide to perform intubation and positive pressure ventilation they must understand the potential risks and how best to minimise them. We suggest that for patients with haemorrhagic shock who do not have a compromised airway and who are able to maintain adequate oxygen saturation (or mentation if monitoring is unreliable) then a strategy of delayed intubation should be strongly encouraged.
Citation:
Airway and ventilation management strategies for haemorrhagic shock. To tube, or not to tube, that is the question! 2018 J Trauma Acute Care Surg
Publisher:
Wolters Kluwer
Journal:
The journal of trauma and acute care surgery
Issue Date:
31-Jan-2018
URI:
http://hdl.handle.net/11287/620619
DOI:
10.1097/TA.0000000000001822
PubMed ID:
29389837
Additional Links:
http://insights.ovid.com/pubmed?pmid=29389837
Type:
Journal Article
Language:
en
ISSN:
2163-0763
Appears in Collections:
Emergency Department; 2018 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorHudson, Anthonyen
dc.contributor.authorStrandenes, G.en
dc.contributor.authorBjerkvig, C. K.en
dc.contributor.authorSvanevik, M.en
dc.contributor.authorGlassberg, E.en
dc.date.accessioned2018-03-02T14:42:57Z-
dc.date.available2018-03-02T14:42:57Z-
dc.date.issued2018-01-31-
dc.identifier.citationAirway and ventilation management strategies for haemorrhagic shock. To tube, or not to tube, that is the question! 2018 J Trauma Acute Care Surgen
dc.identifier.issn2163-0763-
dc.identifier.pmid29389837-
dc.identifier.doi10.1097/TA.0000000000001822-
dc.identifier.urihttp://hdl.handle.net/11287/620619-
dc.description.abstractMany standard trauma management guidelines advocate the early use of endotracheal intubation and positive pressure ventilation as key treatment interventions in haemorrhagic shock. The evidence for using these airway and ventilation strategies to manage a circulation problem is unclear. The potentially harmful effects of drug assisted intubation and positive pressure ventilation include reduced cardiac output, apnoea, hypoxia, hypocapnoea (due to inadvertent hyperventilation) and unnecessarily prolonged on-scene times. Conversely the beneficial effects of spontaneous, negative pressure ventilation upon cardiac output are well described. Few studies, however, have attempted to explore the potential advantages of a strategy of delayed intubation and ventilation (together with a policy of aggressive volume replacement) in shocked trauma patients. Given the lack of evidence, the decision making around how, when and where to subject shocked trauma patients to intubation and positive pressure ventilation remains complex. If providers choose to delay intubation they must have the appropriate skills to safely manage the airway and recognise the need for subsequent intervention. If they decide to perform intubation and positive pressure ventilation they must understand the potential risks and how best to minimise them. We suggest that for patients with haemorrhagic shock who do not have a compromised airway and who are able to maintain adequate oxygen saturation (or mentation if monitoring is unreliable) then a strategy of delayed intubation should be strongly encouraged.en
dc.language.isoenen
dc.publisherWolters Kluweren
dc.relation.urlhttp://insights.ovid.com/pubmed?pmid=29389837en
dc.rightsArchived with thanks to The journal of trauma and acute care surgeryen
dc.subjectWessex Classification Subject Headings::Diseases & disorders of systemic, metabolic or environmental origin::Emergency medicineen
dc.titleAirway and ventilation management strategies for haemorrhagic shock. To tube, or not to tube, that is the question!en
dc.typeJournal Articleen
dc.identifier.journalThe journal of trauma and acute care surgeryen
dc.type.versionIn press (epub ahead of print)en

Related articles on PubMed

All Items in RD&E Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.