Lawrence G. Hampson

THE VALUE OF A CLINICAL SHOCK STUDY PROTOCOL IN THE MANAGEMENT OF REFRACTORY SHOCK

THE SUBJECTS FURNISHED FOR THIS DOCUMENT BY HSRI ARE: SHOCK, INJURY/TRAUMA, ACCIDENT: DIAGNOSIS, MEDICAL, METHODS: LABORATORY, EXPERIMENTAL: CASE STUDY, NATURE OF STUDY, STUDY -REPORT TYPE: BLOOD PRESSURE, PHYSIOLOGICAL, TESTING/ MEASURES: TREATMENT/CARE, RECOVERY OF INJURED: CARDIOVASCULAR SYSTEM, ANATOMY/BODY, BIOMEDICAL ASPECT: INSTRUCTIONS, CONTENTS, STUDY-REPORT TYPE.

Experimental aspiration pneumonia: Hemodynamics, ventilator and membrane oxygenator support

Abstract Cardiopulmonary hemodynamics were studied in anaesthetized mongrel dogs following massive aspiration. Severe hypoxia and acidosis, volume deficit, decreased cardiac output and increased pulmonary resistance were prominent findings, while overt left heart failure does not appear to play an important role in the early stage of aspiration pneumonia. The use of mechanical ventilator support, with added oxygen if needed, is associated with improved oxygenation, more stable hemodynamics and more prolonged survival. In situations where PPV is ineffective due to massive shunting of blood in the lung, effective oxygenation is possible using the membrane oxygenator.

Contribution of airway closure to pulmonary shunting in hypoxemic surgical patients

Airway closure with distal gas trapping has been postulated as one possible mechanism of impaired gas exchange in severely hypoxemic surgical patients, and opening of such units as a mechanism for the reduction in pulmonary shunting associated with the application of positive end-expiratory pressure (PEEP). Direct evidence for such a phenomenon was sought in 11 post-operative and posttraumatic hypoxemic surgical patients by the nitrogen wash-out technique. There was a significant (P < 0.01) improvement in gas exchange but no significant amount of nitrogen reappeared in the expired gas with the application of PEEP or with sighing. From these observations it can be concluded that the decrease in pulmonary shunting observed after utilization of PEEP is not related to reopening of previously closed airways.

Comparison of Effectiveness of Autologous and Nonautologous Plasma in Oligemic Shock in Dogs

A comparison has been made between the effectiveness of nonautologous and autologous plasma as a plasma volume expander in dogs made severely oligemic by acute hemorrhage. No difference was found in their effectiveness in expanding plasma volume or in raising blood pressure. It is suggested that the reactions seen in normal dogs are suppressed in oligemic dogs by catecholamines liberated in response to hypotension.