Surgery
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Randomized Controlled Trial Comparative Study Clinical Trial Historical Article
Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study.
The effects of hemodynamic resuscitation with protein-containing or balanced salt solution were studied prospectively in 29 patients undergoing abdominal aortic surgery. Blood loss was replaced with packed red cells and extracellular volume with either Ringer's Lactate (RL) or 5% albumin in Ringer's lactate (ALB). Fluids were given to maintain the pulmonary capillary wedge pressure (PCWP) equal to or within 5 torr above preoperative (PO) levels, the cardiac output (CO) equal to or greater than preoperative values, and the urine output at least 50 ml/hr. ⋯ There were no cases of pulmonary edema associated with low COPs and normal PCWPs in the crystalloid group. These data seriously question the necessity to maintain COP by using protein-containing solutions during acute hemodynamic resuscitation. When titrated to physiological end points, even large volumes of balanced salt solutions are tolerated well.
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Limb loss is the outcome in one third of previously reported popliteal artery injuries. This report summarizes 83 injuries with an amputation rate of 9.6%. Penetrating traumas accounted for 61 (73%) injuries and blunt traumas for 22 (27%). ⋯ Routine distal catheter thrombectomy and frequent intraoperative arteriography promote and confirm complete reconstruction. Early performance of four quadrant fasciotomy is indicated if compartmental hypertension is suspected. Thorough debridement of injured and questionably viable soft tissue and adequate fracture stabilization are integral parts of successful revascularization.
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Comparative Study
Whole blood vs. packed red cells for resuscitation of hemorrhagic shock: an examination of host defense parameters in dogs.
Whole blood vs. packed red cells for resuscitation of acute blood loss in dogs was compared with respect to a number of variables of host defense. Dogs subjected to a controlled blood loss equal to 8% of their body weight exhibited significant depressions in serum protein, C3, IgG, and total opsonic activity when resuscitated with packed red cells in saline. ⋯ There were no differences in the rate of clearance of intravenously injected bacteria indicating an intact reticuloendothelial system (RES) function in both groups. These experiments suggest that whole blood may be preferable to packed cells for resuscitation of acute hemorrhagic shock when the effect on resistance of infection is considered.
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Comparative Study
Comparison of cardiorespiratory effects of crystalline hemoglobin, whole blood, albumin, and Ringer's lactate in the resuscitation of hemorrhagic shock in dogs.
We studied the time course and interactions of hemodynamic, oxygen transport, colloid osmotic pressure (COP), and blood volume responses to 500 ml of crystalline hemoglobin (Hgb), 500 ml of whole blood (WB), 1,000 ml of Ringer's lactate (RL), and 500 ml of plasma protein fraction (PPF) given in random order to 12 mongrel dogs subjected to hemorrhagic shock by the standard Wiggers' technique. In general, hemodynamic and oxygen transport responses were greater and more prolonged after the colloids than after RL. ⋯ This was particularly evidenced by comparison of these responses when each fluid was the first agent used after the hemorrhage. By virtue of its capacity to increase COP and plasma volume and to carry oxygen, Hgb improved both the gross circulation and the tissue perfusion, as indicated by cardiovascular hemodynamics and bulk oxygen transport variables.