Surgery
-
The effects of saline infusion (20 ml/kg/30 minutes) and homologous plasma infusion (20 ml/kg/30 minutes) on the lung fluid balance during increased pulmonary capillary permeability secondary to Escherichia coli endotoxin infusion (1 microgram/kg/15 minutes) were studied in unanesthetized sheep. Saline and homologous plasma infusion increased lung lymph flow by 10.6% and 10.8%, respectively. The bloodless wet-to-dry ratio was 5.1 +/- 0.2 in the saline group and 5.2 +/- 0.2 in the homologous plasma group. ⋯ Changes in pulmonary microvascular pressure predominated over changes in the oncotic pressure gradient. Both saline and homologous plasma infusion increase fluid filtration into the interstitial space by the same magnitude. Therefore neither has a clear advantage in the treatment of pulmonary edema during increased permeability.
-
Pulmonary inhalation injury is a major cause of morbidity and mortality rates in burn victims. But the pathophysiology of parenchymal inhalation injury has not been fully elucidated. In this study, extravascular lung water volume (EVLW) was measured in burn patients with and without inhalation injury. ⋯ In this study, the general clinical criteria for inhalation injury--presence of facial or oropharyngeal burns, carboxyhemoglobin levels, carbonaceous sputum, or closed space injury--did not differentiate patients with airway injury only from those with parenchymal injury. Patients in both groups who died of sepsis had significant (P less than 0.01) increases in EVLW 24 to 48 hours after the clinical onset of sepsis. The normal hydrostatic pressures in these septic patients suggested that the increase in EVLW observed with sepsis was due to an increase in pulmonary capillary membrane permeability.
-
The ability of exogenous ATP-MgCl2 to reverse the inhibition of ATP-dependent intracellular reactions by hemorrhagic shock was studied. Levels of ornithine in the postperfusion fluid were lower in animals receiving ATP-MgCl2 than in placebo-treated control animals (338.6 +/- 167.0 versus 692.1 +/- 67.2 mumol). Arginine levels were higher (399.1 +/- 130.1 versus 34.3 +/- 59.1 mumol) in ATP-MgCl2-treated animals. ⋯ Glutamate levels were not decreased by shock but were significantly increased by treatment with ATP-MgCl2 compared to placebo (190.5 +/- 48.8 versus 122.6 +/- 36.3 mumol). These data indicate that exogenously administered ATP-MgCl2 can reverse the inhibition of ornithine metabolism and the changes in lactate inhibition seen in hemorrhagic shock. These are both intracellular ATP-dependent reactions.
-
The response to a rapidly administered volume infusion (250 ml of 5% albumin over 30 minutes) was studied in 28 critically ill patients. Cardiovascular responses were assessed by means of invasive hemodynamic parameters (i.e., cardiac index [CI], central venous pressure [CVP], pulmonary artery pressure [PAP], and pulmonary capillary wedge [PCWP] pressure as well as radionuclide [RN] angiography). This allowed for the simultaneous measurement of right (RVEF) and left (LVEF) ejection fractions, and right (RVEDV) and left end-diastolic (LVEDV) and end-systolic (LVESV) volumes. ⋯ Clinical assessment of LV filling pressures (PCWP) does not accurately predict the response to volume infusion and does not allow a reliable assessment of the LV preload. This is most likely due to the broad range of LV compliance characteristics noted in critically ill patients. RV function also appears to be important in the clinical response to volume challenge.
-
Randomized Controlled Trial Clinical Trial
Colloid or crystalloid in the resuscitation of hemorrhagic shock: a controlled clinical trial.
The object of this article is to assess the value of human serum albumin (HSA) in the initial resuscitation of hypotensive trauma victims. Thirty-six patients (mean age = 30 years) in shock from trauma who underwent laparotomies were randomly assigned to either Ringer's lactate solution (RL) resuscitation or 4% HSA in RL resuscitation. Both groups received approximately 8L of test fluid and 6U of washed red cells. ⋯ Two patients in each group required mechanical ventilation for longer than 24 hours. No differences were noted in a battery of pulmonary function tests performed daily for 5 days. These results demonstrate that HSA is not essential in this clinical setting for safe and effective resuscitation.