Abstract
The effects of controlled moderate hyperventilation (paCo2∼31 mmHg) on cardiovascular parameters and whole-body-oxygen-uptake (\(\dot VO_2 \))was studied in 10 patients with head injuries, who were unconscious and artificially ventilated at the time of the investigation. \(\dot VO_2 \)was measured with the Beckmann Metabolic Measurement Cart and also calculated from cardiac output and arterio-mixed venous oxygen content difference. A mean increase in \(\dot VO_2 \)(+19.6% of control) was observed after 2 h of hyperventilation. Cardiac output remained unchanged. This resulted in a decrease of venous oxygen content and impaired full oxygenation of the blood. Our results indicate that hyperventilation should not be a routine procedure. Close monitoring of arterial and venous blood gases is recommended, when hyperventilation is applied.
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References
Agnoli H (1968) Adaption of CBF during induced chronic normo-oxic respiratory acidosis. Scand J Clin Lab Invest Suppl 102 VIII:D
Becker PD, Miller JD, Ward JD, Greenberg RP, Young HF, Salaras R (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491
Betz E, Heuser D (1967) Cerebral cortical blood flow during changes of acid-base equilibrium of the brain. J Appl Physiol 23:726
Braun U, Turner E, Freiboth K (1981) Continuous monitoring of oxygen uptake and carbon dioxide elimination in critically ill patients. In: Rügheimer E, Zindler M (eds) Anaesthesiology. Proceedings of the VIIth World Congress of Anaesthesian, Hamburg, 1980. Excerpta Medica, Amsterdam Oxford Princeton (ICS 538), p 665
Braun U, Turner E, Freiboth K (1982) Ein Verfahren zur Bestimmung von O2-Aufnahme und CO2-Abgabe aus den Atemgasen beim beatmeten Patienten. Anaesthesist 31:307
Bruce DA (1978) Outcome following severe head injuries in children. J Neurosurg 48:679
Cain SM (1968) Effect of PCO2 on the relation of lactate and excess lactate to O2 deficit. Am J Physiol 214:1322
Cain SM (1970) Increased oxygen uptake with passive hyperventilation of dog. J Appl. Physiol 28 (1):4
Cannazelli A, Greenblatt M, Rogers GA, Rapport D (1939) The effect of pH changes on the in vitro oxygen consumption of tissues. Am J Physiol 127:290
Cullen DJ, Eger EI (1974) Cardio-vascular effects of carbon dioxide in man. Anesthesiology 41:345
Frost EAM, Aranciba CU, Shuleman K (1979) Pulmonary shunt as a prognostic indicator in head injury. J Neurosurg 50:760
Gobiet W (1977) Ergebnisse intracranieller Druckmessungen im akuten posttraumatischen Stadium. Anaesthesist 16:187
Gobiet W (1978) Diagnostik und Therapie der akuten Hirnschwellung. Intensivbehandlung 4:121
Gobiet W (1979) Intensivtherapie nach Schädel-Hirn-Trauma. Springer Verlag, Berlin Heidelberg New York, p 57
Gordon E (1970) The effect of controlled ventilation on the clinical course of patients with severe traumatic brain injury. In: Russell RWR (ed) Brain and blood flow. Pitman, London, p365
Gordon E (1971) Controlled respiration in the management of patients with traumatic brain injuries. Acta Anaesthiol Scand 15:193
Granholm L, Siesjö BK (1969) The effects of hypercapnia and hypocapnia upon the cerebro spinal fluid lactate and pyruvate concentrations and upon the lactate, pyruvate, ATP, ADP, phosphocreatine and creatine concentrations of cat brain tissue. Acta Physiol Scand 75:257
James HE, Langfitt VS, Krennar VS, Ghostine SY (1977) Treatment of intracranial hypertension. Analysis of 105 consecutive continuous recordings of intracranial pressure. Acta Neurochir. 36:189
Jennett WB (1964) An introduction to neurosurgery. Thomas, Springfield, I
Karetzky MS, Cain SM (1970) Effect of carbon dioxide on oxygen uptake during hyperventilation in normal man. J Appl Physiol 28:8
Khambatta HJ, Sullivan SF (1973) Effects of respiratory alkalosis on oxygen consumption and oxygenation. Anesthesiology 38:53
Kindt GW, Gosch HH (1972) Arterial pCO2 effect of various levels of intracranial pressure. In: Brock M, H Dietz (eds) Intracranial pressure. Springer Verlag, Berlin Heidelberg New York, p 210
Kogure K, Scheinberg P, Reinmuth OM, Fujishima M, Busto R (1970) Mechanisms of cerbebral vasodilation in hypoxia. J Appl Physiol 29:223
Kreienbühl G, Gattiker R (1976) Der Einfluß der arteriellen Kohlensäurespannung auf den Sauerstoffverbrauch während extracorporellem Kreislauf in Hypothermie. Anaesthesist 25:47
Kruskal WH, Wallis WA (1953) Use of ranks in one criterion variance analysis. J Am Statist Assoc 47:583
Lanksch W (1981) Diagnostik und Behandlung von schweren Schädelhìrnverletzungen. Münch Med Wochenschr 123:556
Lawin P, Schoeppner H, Scherer R (1981) Schädel-Hirn-Trauma. In: Lawin P (ed.) Praxis der Intensivbehandlung Thieme, Stuttgart New York, p 51
Lübbers DW (1972) Physiologie der Gehirndurchblutung. In: Gänshirt H (ed) Der Hirnkreislauf. Thieme, Stuttgart, p 214
Luisada A (1967) Mechanism of neurogenic pulmonary edema. Am J Cardiol 20:66
McDowall DG (1971) The cerebral circulation. In: Gray TC, JF Nunn (eds) General Anesthesia Butterworth, London, p 272
Miller JD, Ledingham IMcA (1969) Reduction of increased ICP. Comparison between hyperbaric oxygen versus hyperventilation. Br J Surg 56:630
Miller JD, Staneck A, Langfitt TW (1972) Concepts of cerebral perfusion pressure and vascular compression during intracranial hypertension. Prog Brain Res 35:411
Moss G (1975) Respiratory distress syndrome as a manifestation of primary CNS disturbance. Proceedings of the Second Chicago Symposium on Neurotrauma. Grune & Stratton, New York, p 137
Nahas GG, Poyart C (1967) Effect of arterial pH alterations on metabolic activity of norepinephrine. Am J Physiol 212:765
Price HL (1960) Effects of carbon dioxide on the cardiovascular system. Anesthesiology 21:652
Reulen HJ (1971) Veränderungen der rCBF beim cerebralen Ödem und ihre therapeutische Beeinflussung durch Hyperventilation. Prakt Anästh 6:426
Rossanda M (1968) Prolonged hyperventilation in treatment of unconscious patients with severe brain injuries. Scand J Clin Lab Invest (Suppl 102) 22 XIII:E
Schreiner-Heltjen J (1980) Der Einfluß der arteriellen Kohlensäure-Spannung und des arteriellen pH-Wertes auf den Sauerstoffverbrauch des Gesamtorganismus während der extracorporalen Zirkulation. Anaesthesist 29:300
Schulte am Esch J, Murday H, Pfeifer G (1981) Haemodynamic changes in patients with severe head injury. Acta Neurochir 54:243
Severinghaus JW, Chioli H, Eger EI, Brandstetter B, Hornbein TF (1966) Cerebral blood flow in man at high altitude. Circ Res 19:274
Simmons RL, Ducker TB, Anderson RW (1968) Pathogenesis of pulmonary edema following head trauma. J Trauma 8:800
Small HS, Weitzner SW, Nahas GG (1960) Cerebrospinal fluid pressure during hypercapnia and hypoxia in the dog. Am J Physiol 198:704
Teasdale G, Galbraith H (1981) Headtrauma and intracranial hemorrhage. In: Grenvik A, Safar P (eds) Brain failure and resuscitation. Churchill Livingston, New York Edinburgh London Melbourne, p 185
Tobin RB, Mehlmann MA (1971) pH effects on oxygen consumption and on lactate and pyruvate production by liver slices. Am J Physiol 221:1151
Ui M (1966) A role of phosphofructokinase in pH dependent regulation of glycolysis. Biochem Biophys Acta 124:310
Usinger W, Spaich P (1970) Sauerstoffverbrauch und Kreislauf bei akuten Änderunen des arteriellen pH. Int Z Angew Physiol 28:181
Wollmann H, Smith TC, Stephen GW, Colton ET, Gleaton HE, Alexander SC (1968) Effects of extremes of respiratory and metabolic alkalosis cerebral blood flow in man. J Appl Physiol 24:60
Zervas NT, Hedley-Whyte J (1972) Successful treatment of cerebral herniation in five patients. N Engl J Med 286:1075
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Turner, E., Hilfiker, O., Braun, U. et al. Metabolic and hemodynamic response to hyperventilation in patients with head injuries. Intensive Care Med 10, 127–132 (1984). https://doi.org/10.1007/BF00265801
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DOI: https://doi.org/10.1007/BF00265801