Journal of investigative surgery : the official journal of the Academy of Surgical Research
-
The effects of hydroxyethyl starch-conjugated deferoxamine (HES-DFO), a macromolecular iron chelator, were investigated on eicosanoid release and bowel wall perfusion following cecal ligation puncture (CLP) in rats. Animals were randomly given an intravenous dose of 3.0 ml of HES-DFO or either vehicle (HES) or 9.0 ml saline immediately following completion of the CLP procedure. At 30, 60, 120, and 240 min after sepsis induction, blood pressure and bowel perfusion were measured. ⋯ The antioxidative HES-DFO therapy did not diminish the eicosanoid release after CLP when compared with either HES-treated or saline-infused rats. However, treatment with the polymeric iron chelator resulted in an impaired bowel wall perfusion that was not reflected in alterations in total adenine nucleotide content or in energy charge. Considering hemodynamic and biochemical endpoints, these results are contradictory to the hypothesis that iron-driven oxygen radicals are major determinants of the eicosanoid release that is elevated following CLP-induced sepsis.
-
Comparative Study
Capnographic monitoring of extubated postoperative patients.
Postoperative respiratory monitoring of surgical patients requires assessment of both oxygenation and ventilation. Arterial blood gas (ABG) measurements traditionally have been used to detect elevated arterial carbon dioxide (PaCO2) concentrations. The recent availability of a noninvasive technique for end-tidal CO2 measurements (EtCO2) may allow substitution of this real-time modality for the more cumbersome blood gas determinations. ⋯ We conclude that on-line EtCO2 measurements provide a useful substitute for routine ABG determinations of PaCO2 in selected patients. The nasopharyngeal catheter provides both a patent airway and undiluted gas for evaluation. This methodology can improve patient comfort and safety considerably while decreasing cost and discomfort.
-
The combined cardiovascular effects of hemorrhagic shock and mechanical brain injury were modeled in five groups of pigs. Standard and hypertonic saline resuscitation of hypotension were evaluated. Changes in mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), intracranial pressure (ICP), and brain water were measured. ⋯ Volumes of saline required to restore blood pressure were large (> 6 L in 3 hours). 1.8% saline produced less rise in ICP than 0.9% saline but was less effective in restoring blood pressure. Brain edema was not decreased with 1.8% saline. Brain injury altered vascular compensation to hemorrhage and made accepted resuscitative measures ineffective.
-
The assessment of pulmonary injury in experimental and clinical situations remains a challenge. A method of quantifying pulmonary vascular aberrations in animal models and human clinical situations is described. A multiple-indicator dilution technique is employed to assess changes in lung capillary permeability--surface area product, extravascular lung water, and cardiac output. ⋯ Normal reference curves are constructed for all subject groups. Significant changes occurred in capillary-permeability surface area product and extravascular lung water in various experimental models producing injury, in the patient population manifesting adult respiratory distress syndrome, and in those patients who have received cardiopulmonary transplants. The multiple-indicator dilution technique represents a sensitive tool for evaluating pulmonary vascular changes.