The Perils of Hyperventilation
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More is not better!
Higher respiratory rates and/or excessive volumes during manual resuscitation result in the increased likelihood of morbidity and mortality. Studies indicate that hyperventilation is happening at alarming rates and frequencies both inside and outside of hospital settings. The longer the period of hyperventilation, the more likely the patient is to experience related complications such as... |
1. Decreased likelihood of survival
2. Cerebral hypoxia resulting in a corresponding decrease in the chances of baseline neurological outcome and increased chances of permanent neurological damage
3. Reduced cardiac output and blood pressure
4. Gastric inflation resulting in emesis, aspiration and subsequent pneumonia
5. Lung damage
Learn more from the links below.
2. Cerebral hypoxia resulting in a corresponding decrease in the chances of baseline neurological outcome and increased chances of permanent neurological damage
3. Reduced cardiac output and blood pressure
4. Gastric inflation resulting in emesis, aspiration and subsequent pneumonia
5. Lung damage
Learn more from the links below.
References
Aufderheide, T. & Lurie, K. (2004) Death by hyperventilaion: A common and life threatening problem during cardiopulmonary resuscitation. Journal of Critical Care Medicine. Retrieved from https://www.researchgate.net/publication/8207887_Death_by_hyperventilation_A_common_and_life-threatening_problem_during_cardiopulmonary_resuscitation
Aufderheide, T., Gardar, S., Pirrallo, R., Yannopoulos, D., McKnite, S., Briesen, C., Sparks, C., Conrad, C., Provo, T., & Lurie, K. (2004) Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation. American Heart Assocation Journal. Retrieved from http://circ.ahajournals.org/content/109/16/1960
Abella, B., Alvarado, J., Myklebust, H., Edelson, D., Barry, A., O'Hearn, N, Vanden Hoek, T., & Becker, L. (2005) Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest. The Journal of the American Medicine Association. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=200195
Han, M. et al. (2011). Short Women With Severe Sepsis-Related Acute Lung Injury Receive Lung Protective Ventilation Less Frequently: An Observational Cohort Study. Critical Care. Retrieved from http://ccforum.biomedcentral.com/articles/10.1186/cc10524
Hasegawa, K. et al. (2013) Association of Prehospital Advanced Airway Management with Neurologic Outcome and Survival in Patients with Out-of-Hospital Cardiac Arrest. The Journal of American Medical Association, (309), 3. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=1557712
Kohler, K., Losert, H., Sterz, F., et al., (2006) Quality of Cardio Pulmonary Resuscitation Among Highly Trained Staff in an Emergency Department Setting. Arch Intern Med, 166: 2375–80.
http://archinte.jamanetwork.com/article.aspx?articleid=411316
Link, M., Berkow, L., Kudenchuk, P., Halperin, H., Hess, E., Moitia, V., Neuman, R., O'Neil, B., Paxton, J., Silvers, S., White, R., Yannopoulos, D., & Donnino, M. (2015). American Heart Association Guidelines Update for Cadiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association Adult Advanced Cardiovascular Life Support. Retrieved from http://circ.ahajournals.org/content/132/18_suppl_2/S444.full
McInnes, A., Sutton, R., Orioles, A., Nishisaki, A., Niles, D., Abella, B., Maltese, M. & Berg, R. (2011) The First Quantitative Report of Ventilation Rate During Resuscitation of Older Children and Adolescents. Resuscitation, 82(8). Retrieved from
www.sciencedirect.com/science/article/pii/S0300957211002139
Milander, M., Hiscok, P., Sanders, A., Kern, K., Berg, R. & Ewy, G. (1995) Chest Compression and Ventilation Rates During Cardiopulmonary Resuscitation: The Effects of Audible Tone Guidance. Academic Emergency Medicine, 2(8). Retrieved from www.ncbi.nlm.nih.gov/pubmed/7584749
Mondolfi, A., Bachur, R., Grenier, B., & Thompson, J. (1997) Comparison of Self-Inflating Bags with Anesthesia Bags for Bag-Mask Ventilation in the Pediatric Emergency Department. Pediatric Emergency Care. 13(5). Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/9368241
Niebauer, J., White M., Zinkan J., Youngblood A. & Tofil N. (2011) Hyperventilation in Pediatric Resuscitation: Performance in Simulated Pediatric Medical Emergencies. Retrieved from http://pediatrics.aappublications.org/content/128/5/e1195
O'Neill, J. & Deakin, C. (2007). Do we hyperventilate cardiac arrest patients? Resuscitation. DOI 10.1016/j.resuscitation.2006.09.01. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17289248?dopt=Abstract
Weiler, N., Heinrichs, W. & Dick, W. (1995) Assessment of Pulmonary Mechanics and Gastric Inflation Pressure During Mask Ventilation. Prehospital Disaster Medicine, 10(2). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10155411?dopt=Abstract
Aufderheide, T., Gardar, S., Pirrallo, R., Yannopoulos, D., McKnite, S., Briesen, C., Sparks, C., Conrad, C., Provo, T., & Lurie, K. (2004) Hyperventilation-Induced Hypotension During Cardiopulmonary Resuscitation. American Heart Assocation Journal. Retrieved from http://circ.ahajournals.org/content/109/16/1960
Abella, B., Alvarado, J., Myklebust, H., Edelson, D., Barry, A., O'Hearn, N, Vanden Hoek, T., & Becker, L. (2005) Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest. The Journal of the American Medicine Association. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=200195
Han, M. et al. (2011). Short Women With Severe Sepsis-Related Acute Lung Injury Receive Lung Protective Ventilation Less Frequently: An Observational Cohort Study. Critical Care. Retrieved from http://ccforum.biomedcentral.com/articles/10.1186/cc10524
Hasegawa, K. et al. (2013) Association of Prehospital Advanced Airway Management with Neurologic Outcome and Survival in Patients with Out-of-Hospital Cardiac Arrest. The Journal of American Medical Association, (309), 3. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=1557712
Kohler, K., Losert, H., Sterz, F., et al., (2006) Quality of Cardio Pulmonary Resuscitation Among Highly Trained Staff in an Emergency Department Setting. Arch Intern Med, 166: 2375–80.
http://archinte.jamanetwork.com/article.aspx?articleid=411316
Link, M., Berkow, L., Kudenchuk, P., Halperin, H., Hess, E., Moitia, V., Neuman, R., O'Neil, B., Paxton, J., Silvers, S., White, R., Yannopoulos, D., & Donnino, M. (2015). American Heart Association Guidelines Update for Cadiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association Adult Advanced Cardiovascular Life Support. Retrieved from http://circ.ahajournals.org/content/132/18_suppl_2/S444.full
McInnes, A., Sutton, R., Orioles, A., Nishisaki, A., Niles, D., Abella, B., Maltese, M. & Berg, R. (2011) The First Quantitative Report of Ventilation Rate During Resuscitation of Older Children and Adolescents. Resuscitation, 82(8). Retrieved from
www.sciencedirect.com/science/article/pii/S0300957211002139
Milander, M., Hiscok, P., Sanders, A., Kern, K., Berg, R. & Ewy, G. (1995) Chest Compression and Ventilation Rates During Cardiopulmonary Resuscitation: The Effects of Audible Tone Guidance. Academic Emergency Medicine, 2(8). Retrieved from www.ncbi.nlm.nih.gov/pubmed/7584749
Mondolfi, A., Bachur, R., Grenier, B., & Thompson, J. (1997) Comparison of Self-Inflating Bags with Anesthesia Bags for Bag-Mask Ventilation in the Pediatric Emergency Department. Pediatric Emergency Care. 13(5). Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/9368241
Niebauer, J., White M., Zinkan J., Youngblood A. & Tofil N. (2011) Hyperventilation in Pediatric Resuscitation: Performance in Simulated Pediatric Medical Emergencies. Retrieved from http://pediatrics.aappublications.org/content/128/5/e1195
O'Neill, J. & Deakin, C. (2007). Do we hyperventilate cardiac arrest patients? Resuscitation. DOI 10.1016/j.resuscitation.2006.09.01. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17289248?dopt=Abstract
Weiler, N., Heinrichs, W. & Dick, W. (1995) Assessment of Pulmonary Mechanics and Gastric Inflation Pressure During Mask Ventilation. Prehospital Disaster Medicine, 10(2). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10155411?dopt=Abstract
