Article

Bilateral vagotomy inhibits apnea and attenuates other physiological responses after blunt chest trauma.

Department of Clinical Science and Education, Karolinska Institute at Söder Hospital, Stockholm, Sweden.
The Journal of trauma (impact factor: 2.48). 07/2008; 64(6):1420-6. DOI:10.1097/TA.0b013e318054e247 pp.1420-6
Source: PubMed

ABSTRACT Behind armor blunt trauma (BABT) is defined as the nonpenetrating injury resulting from a ballistic impact on body armor. Some of the kinetic energy is transferred to the body, causing internal injuries and, occasionally, death. The aim of this study was to investigate if apnea and other pathophysiological effects after BABT is a vagally mediated reflex.
Sixteen anesthetized pigs wearing body armor, of which five were vagotomized, were shot with a standard 7.62 mm assault rifle. These animals were compared with control animals (n = 8), shot with blank ammunition. We performed bilateral vagotomy before the shot and assessed the outcome on the apnea period, respiration, circulation, and brain function. Animals were monitored during a 2-hour period after the shot.
Nonvagotomized animals had a mean apnea period of 22 (6-44) seconds. This group also showed a significant decrease in oxygen saturation compared with control animals. Furthermore, electroencephalogram-changes were more pronounced in nonvagotomized animals. In contrast, vagotomized animals were protected from apnea and showed only a minor decrease in oxygen saturation. All exposed animals showed impaired circulation, and postmortem examination revealed a pulmonary contusion.
This study shows that apnea after BABT is a vagally mediated reflex that can be inhibited by bilateral vagotomy. Our results indicate that the initial apnea period is an important factor for hypoxia after BABT. Supported ventilation should begin immediately if the affected person is unconscious and suffers from apnea. It should continue until the neurologic paralysis disappears and sufficient spontaneous breathing begins.

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Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

2-hour period
 
affected person
 
anesthetized pigs
 
apnea period
 
bilateral vagotomy
 
body armor
 
brain function
 
initial apnea period
 
internal injuries
 
mean apnea period
 
neurologic paralysis
 
nonpenetrating injury
 
nonvagotomized animals
 
oxygen saturation
 
pathophysiological effects
 
postmortem examination
 
pulmonary contusion
 
significant decrease
 
sufficient spontaneous breathing
 
Supported ventilation