nach oben

European Journal of Trauma and Emergency Surgery

Erschienen in:

01.08.2013 | Original Article

Influence of vagal injury on acute traumatic reaction after blast injury

verfasst von: Y. Wang, L. Pan, W. Fan, Z. Zhou, L. Zhu, Y. Wang, R. Hu

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 4/2013

Einloggen, um Zugang zu erhalten

Abstract

Introduction

A prospectively randomised, controlled animal study was conducted to analyse the influence of vagal injury on acute cardio-respiratory responses to blast injury.

Materials and methods

We used a previously described model of blast-fragment combined injuries to divide dogs randomly into three groups: normal control, blast injury with fragment shot at the masseter and blast injury with fragment shot at the neck. The vagal histomorphologic changes were investigated by haematoxylin–eosin staining and immunocytochemical analysis of neuron-specific enolase and glial fibrillary acidic protein. The indices of respiration, heart rate, blood pressure and body temperature were recorded continuously before and after blast exposure.

Results

The vagal injury was more severe in the neck-injured than in the face-injured group. However, bradycardia, hypotension and absence of compensatory peripheral vasoconstriction, which are typically seen in animals subjected to blast injury without vagal nerve injuries, were partly inhibited when the vagal nerve was injured.

Conclusion

A vagally mediated reflex, such as a cardio-respiratory system defensive reflex that caused shock, was observed immediately after blast pressure wave injury. These observations may have important implications for the emergency management of blast injury cases.

Chan RK, Siller-Jackson A, Verrett AJ, Wu J, Hale RG. Ten years of war: a characterization of craniomaxillofacial injuries incurred during operations Enduring Freedom and Iraqi Freedom. J Trauma Acute Care Surg. 2012;73:S453–8.PubMedCrossRef

Breeze J, Masterson L, Banfield G. Outcomes from penetrating ballistic cervical injury. J R Army Med Corps. 2012;158:96–100.PubMedCrossRef

Ito E, Ichikawa M, Itakura T, Ando H, Matsumoto Y, Oda K, Sato T, Watanabe T, Sakuma J, Saito K. Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries. J Neurosurg. 2013;118:195–201.PubMedCrossRef

Levy G, Fishman JE, Xu DZ, Dong W, Palange D, Vida G, Mohr A, Ulloa L, Deitch EA. Vagal nerve stimulation modulates gut injury and lung permeability in trauma-hemorrhagic shock. J Trauma Acute Care Surg. 2012;73:338–42.PubMedCrossRef

Lampert R. Evaluation and management of arrhythmia in the athletic patient. Prog Cardiovasc Dis. 2012;54:423–31.PubMedCrossRef

Thompson D, Adams SL, Barrett J. Relative bradycardia in patients with isolated penetrating abdominal trauma and isolated extremity trauma. Ann Emerg Med. 1990;19:268–75.PubMedCrossRef

Irwin RJ, Lerner MR, Bealer JF, Mantor PC, Brackett DJ, Tuggle DW. Shock after blast wave injury is caused by a vagally mediated reflex. J Trauma. 1999;47:105–10.PubMedCrossRef

Guy RJ, Kirkman E, Watkins PE, Cooper GJ. Physiologic responses to primary blast. J Trauma. 1998;45:983–7.PubMedCrossRef

Hicks RR, Fertig SJ, Desrocher RE, Koroshetz WJ, Pancrazio JJ. Neurological effects of blast injury. J Trauma. 2010;68:1257–63.PubMedCrossRef

10.

Borovikova LV, Ivanova S, Zhang M, Yang H, Botchkina GI, Watkins LR, Wang H, Abumrad N, Eaton JW, Tracey KJ. Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature. 2000;405:458–62.PubMedCrossRef

11.

Giuliani D, Ottani A, Altavilla D, Bazzani C, Squadrito F, Guarini S. Melanocortins and the cholinergic anti-inflammatory pathway. Adv Exp Med Biol. 2010;681:71–87.PubMedCrossRef

12.

van Westerloo DJ. The vagal immune reflex: a blessing from above. Wien Med Wochenschr. 2010;160:112–7.PubMedCrossRef

13.

Hopkins DA, Plumier JC, Currie RW. Induction of the 27-kDa heat shock protein (Hsp27) in the rat medulla oblongata after vagus nerve injury. Exp Neurol. 1998;153:173–83.PubMedCrossRef

14.

Cernak I, Savic J, Malicevic Z, Zunic G, Radosevic P, Ivanovic I, Davidovic L. Involvement of the central nervous system in the general response to pulmonary blast injury. J Trauma. 1996;40:S100–4.PubMedCrossRef

15.

Ghaemmaghami V, Gdalevitch P, Gentilello L, Frankel H. Vagal nerve transection after gunshot wound to neck. J Trauma. 2008;64:846.PubMedCrossRef

16.

Säljö A, Arrhén F, Bolouri H, Mayorga M, Hamberger A. Neuropathology and pressure in the pig brain resulting from low-impulse noise exposure. J Neurotrauma. 2008;25(12):1397–406.PubMedCrossRef

17.

Moore DF, Jaffee MS. Military traumatic brain injury and blast. NeuroRehabilitation. 2010;26:179–81.PubMed

18.

Cheng J, Gu J, Ma Y, Yang T, Kuang Y, Li B, Kang J. Development of a rat model for studying blast-induced traumatic brain injury. J Neurol Sci. 2010;294:23–8.PubMedCrossRef

19.

Axelsson H, Hjelmqvist H, Medin A, Persson JK, Suneson A. Physiological changes in pigs exposed to a blast wave from a detonating high-explosive charge. Mil Med. 2000;165:119–26.PubMed

20.

Klimo P Jr, Ragel BT, Rosner M, Gluf W, McCafferty R. Can surgery improve neurological function in penetrating spinal injury? a review of the military and civilian literature and treatment recommendations for military neurosurgeons. Neurosurg Focus. 2010;28:E4.PubMedCrossRef

21.

Vadivelu S, Bell RS, Crandall B, DeGraba T, Armonda RA. Delayed detection of carotid-cavernous fistulas associated with wartime blast-induced craniofacial trauma. Neurosurg Focus. 2010;28:E6.PubMedCrossRef

22.

Howe LL. Giving context to post-deployment post-concussive-like symptoms: blast-related potential mild traumatic brain injury and comorbidities. Clin Neuropsychol. 2009;23:1315–37.PubMedCrossRef

23.

Hoffman SW, Harrison C. The interaction between psychological health and traumatic brain injury: a neuroscience perspective. Clin Neuropsychol. 2009;23:1400–15.PubMedCrossRef

24.

Holt GR, Kostohryz G Jr. Wound ballistics of gunshot injuries to the head and neck. Arch Otolaryngol. 1983;109:313–8.PubMedCrossRef

25.

Kline DG. Civilian gunshot wounds to the brachial plexus. J Neurosurg. 1989;70:166–74.PubMedCrossRef

26.

Vrebalov-Cindro V, Reic P, Ognjenovic M, Jankovic S, Andelinovic S, Karelovic D, Kapural L, Rakic M, Primorac D. Peripheral nerve war injuries. Mil Med. 1999;164:351–2.PubMed

27.

Hamdan TA. Missed injuries in casualties from the Iraqi–Iranian war: a study of 35 cases. Injury. 1987;18:15–7.PubMedCrossRef

28.

Suneson A, Hansson HA, Seeman T. Pressure wave injuries to the nervous system caused by high-energy missile extremity impact: Part I. Local and distant effects on the peripheral nervous system—a light and electron microscopic study on pigs. J Trauma. 1990;30:281–94.PubMedCrossRef

29.

Breeze J, Allanson-Bailey LS, Hunt NC, Delaney RS, Hepper AE, Clasper J. Mortality and morbidity from combat neck injury. J Trauma Acute Care Surg. 2012;72:969–74.PubMed

30.

Puri V, Mahendru S, Rana R, Deshpande M. Firework injuries: a ten-year study. J Plast Reconstr Aesthet Surg. 2009;62:1103–11.PubMedCrossRef

31.

Wang Z, Liu Y, Lei D, Bai Z, Zhou S. A new model of blast injury from a spherical explosive and its special wound in the maxillofacial region. Mil Med. 2003;168:330–2.PubMed

32.

Rosenfeld JV, Ford NL. Bomb blast, mild traumatic brain injury and psychiatric morbidity: a review. Injury. 2010;41:437–43.PubMedCrossRef

33.

Jastrow KM 3rd, Gonzalez EA, McGuire MF, Suliburk JW, Kozar RA, Iyengar S, Motschall DA, McKinley BA, Moore FA, Mercer DW. Early cytokine production risk stratifies trauma patients for multiple organ failure. J Am Coll Surg. 2009;209:320–31.PubMedCrossRef

34.

Garner J, Watts S, Parry C, Bird J, Cooper G, Kirkman E. Prolonged permissive hypotensive resuscitation is associated with poor outcome in primary blast injury with controlled hemorrhage. Ann Surg. 2010;251:1131–9.PubMedCrossRef

35.

Knöferl MW, Liener UC, Seitz DH, Perl M, Brückner UB, Kinzl L, Gebhard F. Cardiopulmonary, histological, and inflammatory alterations after lung contusion in a novel mouse model of blunt chest trauma. Shock. 2003;19:519–25.PubMedCrossRef

36.

Sawdon M, Ohnishi M, Watkins PE, Kirkman E. The effects of primary thoracic blast injury and morphine on the response to haemorrhage in the anaesthetised rat. Exp Physiol. 2002;87:683–9.PubMedCrossRef

37.

Ohnishi M, Kirkman E, Guy RJ, Watkins PE. Reflex nature of the cardiorespiratory response to primary thoracic blast injury in the anaesthetised rat. Exp Physiol. 2001;86:357–64.PubMedCrossRef

38.

Rafaels KA, Bass CR, Panzer MB, Salzar RS. Pulmonary injury risk assessment for long-duration blasts: a meta-analysis. J Trauma. 2010;69:368–74.PubMedCrossRef

39.

Yang C, Yan J, Wang HY, Zhou LL, Zhou JY, Wang ZG, Jiang JX. Effects of bilateral adrenalectomy on the innate immune responses following trauma in rats. Injury. 2011;42:905–12.PubMedCrossRef

40.

Rady MY. Bench-to-bedside review: resuscitation in the emergency department. Crit Care. 2005;9:170–6.PubMedCrossRef

41.

Rady MY. Possible mechanisms for the interaction of peripheral somatic nerve stimulation, tissue injury, and hemorrhage in the pathophysiology of traumatic shock. Anesth Analg. 1994;78:761–5.PubMedCrossRef

Titel: Influence of vagal injury on acute traumatic reaction after blast injury
verfasst von: Y. Wang
L. Pan
W. Fan
Z. Zhou
L. Zhu
Y. Wang
R. Hu
Publikationsdatum: 01.08.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 4/2013
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-013-0277-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

25.04.2024 | Hypertonie | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Influence of vagal injury on acute traumatic reaction after blast injury

Abstract

Introduction

Materials and methods

Results

Conclusion

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Introduction

Materials and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2013

Technical complications during removal of locking screws from locking compression plates: a prospective multicenter study

Metal removal

Cause of death and time of death distribution of trauma patients in a Level I trauma centre in the Netherlands

More on acetabular fractures: the Trojan War and the Roman Empire

Management of chronic traumatic arteriovenous fistula of the lower extremities

Epidemiology and management of trauma patients in a Greek multispecialty hospital in the absence of a dedicated trauma center

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie