Lung and Diaphragm Damage at Varying Oxygen Levels and Ventilator Modes Post Hemorrhagic Shock

Hemorrhagic shock is a major cause of morbidity and mortality for the U.S. Armed Forces in the context of combat injuries occurring in Operations Iraqi and Enduring Freedom. Prevention and treatment of injured lung tissue and diaphragm dysfunction constitute military nursing priorities. A major treatment strategy applicable to hemorrhagic shock patients is that of improving oxygen delivery to tissues. The current nursing practice is to maximize the inspired oxygen concentration. However, too high of inspired oxygen can be toxic, whereas, too low of concentration can cause tissue hypoxia. Thus, our investigation would assist military nurses in determining the optimal oxygen concentration with and without dopamine following hemorrhagic shock. These experiments could improve both lung and diaphragm function which is crucial and important to improving care for injured military personnel. For military personnel experiencing severe hemorrhagic shock, controlled mechanical ventilation may be required introducing the risk of ventilator-induced lung injury. An understanding of the effects of three different control modes on lung damage would be a significant addition to mechanical ventilation protocols.

Two of five TriService Nursing Research Program Priorities are targeted by this study. The first priority is military deployment health. Our research will assist in determining what the optimal oxygen concentration is and controlled mechanical ventilation mode to use on military personnel during deployment if they experience hemorrhagic shock. Our study will also address the priority of generating knowledge related to military nursing practice; it determines the quantity of oxygen free radicals and degree of apoptosis produced in the lungs and diaphragm. This new information is essential in preventing tissue toxicity and implementing important clinical interventions post hemorrhage.

This research will expand the body of scientific knowledge by providing data that is critical to military personnel for optimizing oxygenation and preventing further lung and diaphragm damage. By reducing free radicals, there would be less hyperoxic lung injury, adult respiratory distress syndrome and decrease the time on mechanical ventilation following hemorrhagic shock. We believe these data would provide scientific insights into why hemorrhagic shock patients experience ventilator-induced lung injury. All of the proposed experiments will expand military nurses' knowledge and improve their capacity to provide appropriate and high-quality nursing care for military personnel who suffer from hemorrhagic shock.

Final Report is available on NTRL at: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013101...