Hemodynamic effects of supplemental oxygen versus air in simulated blood loss in healthy volunteers: a randomized, controlled, double-blind, crossover trial.
Cardiac output
Cerebrovascular circulation
Hemodynamic
Hypovolemia
Lower body negative pressure
Oxygen inhalation therapy
Randomized controlled trial
Trauma
Journal
Intensive care medicine experimental
ISSN: 2197-425X
Titre abrégé: Intensive Care Med Exp
Pays: Germany
ID NLM: 101645149
Informations de publication
Date de publication:
10 Nov 2023
10 Nov 2023
Historique:
received:
17
07
2023
accepted:
01
11
2023
medline:
10
11
2023
pubmed:
10
11
2023
entrez:
10
11
2023
Statut:
epublish
Résumé
Trauma patients frequently receive supplemental oxygen, but its hemodynamic effects in blood loss are poorly understood. We studied the effects of oxygen on the hemodynamic response and tolerance to simulated blood loss in healthy volunteers. Fifteen healthy volunteers were exposed to simulated blood loss by lower body negative pressure (LBNP) on two separate visits at least 24 h apart. They were randomized to inhale 100% oxygen or medical air on visit 1, while inhaling the other on visit 2. To simulate progressive blood loss LBNP was increased every 3 min in levels of 10 mmHg from 0 to 80 mmHg or until hemodynamic decompensation. Oxygen and air were delivered on a reservoired face mask at 15 L/min. The effect of oxygen compared to air on the changes in cardiac output, stroke volume and middle cerebral artery blood velocity (MCAV) was examined with mixed regression to account for repeated measurements within subjects. The effect of oxygen compared to air on the tolerance to blood loss was measured as the time to hemodynamic decompensation in a shared frailty model. Cardiac output was the primary outcome variable. Oxygen had no statistically significant effect on the changes in cardiac output (0.031 L/min/LBNP level, 95% confidence interval (CI): - 0.015 to 0.077, P = 0.188), stroke volume (0.39 mL/LBNP level, 95% CI: - 0.39 to 1.2, P = 0.383), or MCAV (0.25 cm/s/LBNP level, 95% CI: - 0.11 to 0.61, P = 0.176). Four subjects exhibited hemodynamic decompensation when inhaling oxygen compared to 10 when inhaling air (proportional hazard ratio 0.24, 95% CI: 0.065 to 0.85, P = 0.027). We found no effect of oxygen compared to air on the changes in cardiac output, stroke volume or MCAV during simulated blood loss in healthy volunteers. However, oxygen had a favorable effect on the tolerance to simulated blood loss with fewer hemodynamic decompensations. Our findings suggest that supplemental oxygen does not adversely affect the hemodynamic response to simulated blood loss. Trial registration This trial was registered in ClinicalTrials.gov (NCT05150418) December 9, 2021.
Sections du résumé
BACKGROUND
BACKGROUND
Trauma patients frequently receive supplemental oxygen, but its hemodynamic effects in blood loss are poorly understood. We studied the effects of oxygen on the hemodynamic response and tolerance to simulated blood loss in healthy volunteers.
METHODS
METHODS
Fifteen healthy volunteers were exposed to simulated blood loss by lower body negative pressure (LBNP) on two separate visits at least 24 h apart. They were randomized to inhale 100% oxygen or medical air on visit 1, while inhaling the other on visit 2. To simulate progressive blood loss LBNP was increased every 3 min in levels of 10 mmHg from 0 to 80 mmHg or until hemodynamic decompensation. Oxygen and air were delivered on a reservoired face mask at 15 L/min. The effect of oxygen compared to air on the changes in cardiac output, stroke volume and middle cerebral artery blood velocity (MCAV) was examined with mixed regression to account for repeated measurements within subjects. The effect of oxygen compared to air on the tolerance to blood loss was measured as the time to hemodynamic decompensation in a shared frailty model. Cardiac output was the primary outcome variable.
RESULTS
RESULTS
Oxygen had no statistically significant effect on the changes in cardiac output (0.031 L/min/LBNP level, 95% confidence interval (CI): - 0.015 to 0.077, P = 0.188), stroke volume (0.39 mL/LBNP level, 95% CI: - 0.39 to 1.2, P = 0.383), or MCAV (0.25 cm/s/LBNP level, 95% CI: - 0.11 to 0.61, P = 0.176). Four subjects exhibited hemodynamic decompensation when inhaling oxygen compared to 10 when inhaling air (proportional hazard ratio 0.24, 95% CI: 0.065 to 0.85, P = 0.027).
CONCLUSIONS
CONCLUSIONS
We found no effect of oxygen compared to air on the changes in cardiac output, stroke volume or MCAV during simulated blood loss in healthy volunteers. However, oxygen had a favorable effect on the tolerance to simulated blood loss with fewer hemodynamic decompensations. Our findings suggest that supplemental oxygen does not adversely affect the hemodynamic response to simulated blood loss. Trial registration This trial was registered in ClinicalTrials.gov (NCT05150418) December 9, 2021.
Identifiants
pubmed: 37947905
doi: 10.1186/s40635-023-00561-z
pii: 10.1186/s40635-023-00561-z
pmc: PMC10638149
doi:
Banques de données
ClinicalTrials.gov
['NCT05150418']
Types de publication
Journal Article
Langues
eng
Pagination
76Informations de copyright
© 2023. The Author(s).
Références
Am J Physiol Regul Integr Comp Physiol. 2018 Jul 1;315(1):R1-R27
pubmed: 29488785
Crit Care. 2023 Mar 1;27(1):80
pubmed: 36859355
J Trauma Acute Care Surg. 2014 Aug;77(2):213-8
pubmed: 25058244
Acta Anaesthesiol Scand. 2019 Apr;63(4):531-536
pubmed: 30520014
PLoS One. 2022 Jun 24;17(6):e0270598
pubmed: 35749486
J Neurosci Methods. 2011 Mar 30;196(2):221-37
pubmed: 21276818
ATS Sch. 2022 Oct 12;3(4):631-633
pubmed: 36726703
J Trauma. 2007 Dec;63(6):1338-46; discussion 1346-7
pubmed: 18212658
Crit Care. 2018 Feb 25;22(1):45
pubmed: 29477145
BMJ Open. 2022 Nov 07;12(11):e064047
pubmed: 36344005
Physiol Rev. 2019 Jan 1;99(1):807-851
pubmed: 30540225
J Int Med Res. 2008 Mar-Apr;36(2):227-36
pubmed: 18380931
J Appl Physiol (1985). 2014 Nov 15;117(10):1081-3
pubmed: 25257879
Med Biol Eng Comput. 1990 Nov;28(6):555-60
pubmed: 2287179
Scand J Trauma Resusc Emerg Med. 2021 Sep 10;29(1):134
pubmed: 34507593
Lancet. 2018 Apr 28;391(10131):1693-1705
pubmed: 29726345
Curr Opin Crit Care. 2011 Jun;17(3):290-5
pubmed: 21508838
Acta Med Scand. 1970 Nov;188(5):419-24
pubmed: 5490570
BMJ Open. 2018 Jul 6;8(7):e020880
pubmed: 29982208
J Physiol. 1995 Feb 15;483 ( Pt 1):289-98
pubmed: 7776239
PLoS One. 2019 Jun 28;14(6):e0219154
pubmed: 31251778
J Rheumatol. 2022 Aug;49(8):867-870
pubmed: 35105710
Physiol Rev. 2021 Oct 1;101(4):1487-1559
pubmed: 33769101
Crit Care. 2021 Dec 19;25(1):440
pubmed: 34924022
Eur J Appl Physiol. 2021 Aug;121(8):2207-2217
pubmed: 33890157
J Hum Hypertens. 2014 Mar;28(3):193-200
pubmed: 24067349
BMJ. 2019 Jul 31;366:l4378
pubmed: 31366597