Chest wall and lung mechanics during acute hemorrhage in anesthetized dogs

Abstract

Objectives: In trauma and in surgical patients, respiratory mechanics may change because of many factors, including the hypotension induced by hemorrhage. The effects of acute hemorrhage on elastic and resistive characteristics of the respiratory system were studied. Design: Prospective study. Setting: Anesthesia research laboratory. Interventions: Acute hemorrhagic shock was induced in 24 supine anesthetized/paralyzed, mechanically ventilated dogs by blood withdrawal over a 12-minute period to decrease systolic arterial pressure to 50 mmHg; additional blood was subsequently withdrawn to maintain this pressure for 2 hours. Total respiratory system dynamic compliance and resistance and lung and chest wall compliances and resistances were measured. Measurements and Main Results: Total respiratory system dynamic compliance decreased from control (0.03 ± 0.002 L/cmH 2O) by the first 10 minutes of shock ( p < 0.05) and was 9.8 ± 2% lower than control 2 hours after the induction of shock because of decreases in both lung (9.6 ± 3%) and chest wall (7.7 ± 3%) compliances. Total respiratory resistance increased 12.8 ± 3% from control (3.08 ± 0.19 cmH 2O/L/s) after 2 hours of shock ( p < 0.05) because of an increase in chest wall resistance (21.6 ± 8%, p < 0.05). Pulmonary resistance was not significantly increased ( p >; 0.05). In six control dogs, prepared similarly but not hemorrhaged, chest wall compliance and resistance did not change, but lung compliance gradually decreased by 17.8% during 150 minutes of anesthesia/paralysis. Lung resistance increased only after 100 minutes ( p < 0.05). Conclusions: (1) Hemorrhagic shock caused slight changes in the chest wall, but effects on lung mechanics were a consequence of prolonged mechanical ventilation during anesthesia/paralysis, and (2) changes in respiratory mechanics caused by hemorrhagic shock are small and, unless other deleterious factors are present, would probably have little clinical significance.