Document Detail


Shock, transfusion, and pneumonectomy. Death is due to right heart failure and increased pulmonary vascular resistance.
MedLine Citation:
PMID:  2375651     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To determine the physiologic cardiopulmonary abnormalities leading to death when pneumonectomy is required to stop bleeding in patients in hemorrhagic shock, we compared cardiopulmonary responses to resuscitation in pigs undergoing hemorrhagic shock alone, pneumonectomy alone, and hemorrhagic shock plus pneumonectomy. Four shock-plus-pneumonectomy pigs died acutely from right heart failure. When the five remaining shock-plus-pneumonectomy pigs were compared to the two control groups, pulmonary vascular resistance (PVR) increased to significantly higher levels than would be expected from the increase in PVR noted with resuscitation from shock alone and pneumonectomy alone. Right ventricular compensation maintained cardiac index in the hemorrhage-alone group and the pneumonectomy-alone group but could not maintain cardiac index in the shock-plus-pneumonectomy group, despite maximal increases in right ventricular systolic pressure, heart rate, and right ventricular end diastolic volume. These data indicated that resuscitation from shock plus pneumonectomy cannot be effectively accomplished because increased PVR leads to right ventricular failure, which limits left ventricular preload to levels that are insufficient to maintain cardiac index.
Authors:
H G Cryer; C Mavroudis; J Yu; A M Roberts; J I Cué; J D Richardson; H C Polk
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  212     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1990 Aug 
Date Detail:
Created Date:  1990-08-28     Completed Date:  1990-08-28     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  197-201     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Price Institute of Surgical Research, Louisville, Kentucky.
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Pressure
Blood Transfusion*
Cardiac Output
Cardiac Output, Low / blood,  etiology*,  physiopathology
Heart / physiopathology
Lactates / blood
Lactic Acid
Lung Injury
Pneumonectomy*
Pulmonary Artery / physiopathology
Pulmonary Circulation*
Pyruvates / blood
Pyruvic Acid
Resuscitation
Shock, Hemorrhagic / blood,  complications,  physiopathology*
Swine
Vascular Resistance
Chemical
Reg. No./Substance:
0/Lactates; 0/Pyruvates; 127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid
Comments/Corrections

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