Document Detail

Early physiologic patterns in acute illness and accidents: toward a concept of circulatory dysfunction and shock based on invasive and noninvasive hemodynamic monitoring.
MedLine Citation:
PMID:  8968973     Owner:  NLM     Status:  MEDLINE    
The aim of the present study was to explore methods, concepts, and techniques that provide recognition of circulatory deficiencies at the earliest possible time in the patient's illness. We used both the standard invasive pulmonary artery thermodilution catheter and noninvasive hemodynamic monitoring systems consisting of a new bioimpedance cardiac output device, pulse oximetry, transcutaneous oxygen (PtCO2) and carbon dioxide tensions as well as the transcutaneous oxygen tension/fraction of inspired oxygen ratio (PtCO2/FIO2). These three noninvasive systems were used to evaluate cardiac function, pulmonary function, and tissue perfusion, respectively. This approach to early noninvasive monitoring is based on recent evidence suggesting that poor tissue perfusion and oxygenation initiate circulatory dysfunction that leads to shock and organ failure. We studied 303 acute episodes of circulatory dysfunction and shock in 261 patients in a university-run county hospital; 75 were acute traumatic injuries and 109 acute nontrauma medical emergencies on admission to the emergency department, and 77 ICU patients with an acute illness or exacerbation of their current illness. The study was a prospective, descriptive study to identify early abnormal circulatory patterns reflecting the cardiac, pulmonary, and perfusion functions associated with death and with survival. We described noninvasively monitored patterns in individual illustrative cases, in common etiologic groups, and in physiologic categories representing various abnormal functional patterns. We found that hypotensive shock usually was preceded by episodes of high flow followed by low flow and inadequate tissue perfusion indicated by reduced PtCO2; this frequent pattern was modified by associated co-morbid conditions, especially hypovolemia, limited cardiac reserve capacity, age, hypertensive states, and increased body metabolism from infection, trauma, stress, exercise, temperature, and endocrine disorders. Reduced pulmonary function occurred in 18% of emergency patients; these were usually patients with thoracic trauma, severe hypovolemia, head injuries, chronic obstructive pulmonary disease, asthma, drug overdose, and central nervous system failure (massive stroke and coma). We concluded that noninvasive measurements identify early circulatory problems reliably and provide objective criteria for physiologic analysis as well as for definition of therapeutic goals and titration of therapy.
W C Shoemaker; C C Wo; D Demetriades; H Belzberg; J A Asensio; E E Cornwell; J A Murray; T V Berne; J Adibi; R S Patil
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  New horizons (Baltimore, Md.)     Volume:  4     ISSN:  1063-7389     ISO Abbreviation:  New Horiz     Publication Date:  1996 Nov 
Date Detail:
Created Date:  1997-03-26     Completed Date:  1997-03-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9416195     Medline TA:  New Horiz     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  395-412     Citation Subset:  IM    
Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033, USA.
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MeSH Terms
Aged, 80 and over
Blood Circulation
Blood Gas Monitoring, Transcutaneous
Cardiac Output
Critical Illness
Electric Impedance
Middle Aged
Monitoring, Physiologic*
Oxygen / blood
Prospective Studies
Shock / physiopathology*
Shock, Traumatic / physiopathology
Grant Support
Reg. No./Substance:

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