Document Detail


Hemodynamic patterns of survivors and nonsurvivors during high risk elective surgical operations.
MedLine Citation:
PMID:  10552119     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Postoperative survivors' and nonsurvivors' hemodynamic and oxygen transport patterns have been extensively studied, and the early postoperative circulatory events leading to organ failures and death have been documented. Outcome was improved when potentially lethal circulatory patterns were treated during the early (the first 8-12 hours) postoperative period; but after the appearance of organ failure, reversal of nonsurvival patterns did not improve the outcome. The purpose of this study was to describe prospectively intraoperative circulatory deficiencies that precede shock, organ failures, and death. The ultimate aim was to elucidate nonsurvivor patterns at the earliest possible time to develop more effective preventive strategies for lethal organ failures. This approach is based on the assumption that it is easier and more effective to prevent the initiators of shock, such as hypovolemia, hypoxemia, poor tissue perfusion, and tissue hypoxia, than to treat the mediators of organ failure, such as cytokines, antigens, eicosinoids, and heat shock proteins. We monitored 356 high risk elective surgical patients with preoperative and intraoperative hemodynamic monitoring by the pulmonary artery (PA) thermodilution catheter. The conventionally monitored mean arterial pressure and heart rate remained in the normal range in both groups; the nonsurvivor pattern included decreased cardiac index, stroke index, stroke work, oxygen delivery, and oxygen consumption. Low oxygen consumption was partly compensated by increased oxygen extraction rates, and arterial pressures were maintained by increasing systemic vascular resistance. The early temporal pattern of nonsurvivors' changes were similar to those described during the postoperative period that preceded development of organ failure and death. This suggests that lethal circulatory dysfunctions may begin during the intraoperative period but become more apparent before and after organs fail during later postoperative stages.
Authors:
W C Shoemaker; C C Wo; D Thangathurai; G Velmahos; H Belzberg; J A Asensio; D Demetriades
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  23     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  1999 Dec 
Date Detail:
Created Date:  1999-12-10     Completed Date:  1999-12-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1264-70; discussion 1270-1     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Southern California School of Medicine, 1200 N. State Street, Room 9900, Los Angeles, California 90033, USA.
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MeSH Terms
Descriptor/Qualifier:
Catheterization, Central Venous
Female
Hemodynamics*
Humans
Male
Middle Aged
Monitoring, Intraoperative / methods*
Oxygen Consumption
Prospective Studies
Risk Factors
Shock, Surgical / diagnosis
Surgical Procedures, Elective / mortality*
Survival Analysis
Thermodilution
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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