Critical care medicine
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Critical care medicine · Apr 1979
Experimental evaluation of 2F transthoracic thermodilution cardiac outputs in small animals.
Cardiac output can be measured with a computer using a 2F transthoracic catheter placed during surgery. When injections are made into a central venous catheter, this technique allows for cardiac output measurements to be made in children with complex congenital heart disease not appropriate for placement of a transvenous pulmonary artery catheter. ⋯ The relationship between green dye and thermodilution was statistically significant (p less than 0.001) and almost linear (r = 0.92). This documents the validity of both the 2F transthoracic catheter technique in the low range of cardiac outputs appropriate for infants and children.
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Critical care medicine · Apr 1979
Studies in shock and resuscitation, I: use of a hypertonic, albumin-containing, fluid demand regimen (HALFD) in resuscitation.
We have reevaluated and clinically tested the current concepts of shock and resuscitation on a logical, physiological, and physical basis. We have considered the currently accepted resuscitation paradigm which is based upon the thesis that early rapid resuscitation of "lost" fluid volume is mandatory and that adequacy of resuscitation can be evaluated by central venous pressure, PAP, PAWP, pulse rate, blood pressure, and/or urine volume. Such methods also accept as natural concomitants that capillary beds are "damaged by injury"; that they "leak" salt, fluid, and albumin; and that these are expected occurrences which are injury-related. ⋯ The results indicate that significantly smaller volumes of fluid were needed to resuscitate the patients in group A with a significantly more rapid normalization of physical, physiological, and biochemical parameters. We conclude that the physically and physiologically appropriate method of resuscitation, demonstrated in burn injury, comprises the use of a fluid given at a rate: (1) to maintain mean arterial and hydrostatic pressures within normal range; (2) that delivers a volume per unit time which does not exceed the capacity of the currently available functional vascular space; (3) that replaces concurrent measurable fluid losses; (4) that is hypertonic (to normalize capillary/tissue osmotic gradients); and (5) that contains colloid (to normalize capillary/tissue osmotic gradients); and (5) that contains colloid (to normalize capillary/tissue oncotic gradients). We further conclude that salt, fluid, and colloid loss into the interstitium during resuscitation frequently is due to the rate delivered and/or the physical nature of the fluid used and not to capillary bed damage outside the zone of injury.