- Email: [email protected]
Optimal composition of burn resuscitation fluids
121 ture. arterial pH, plasma glucose, and osmolality also influenced recovery. There was no correlation of EEG recovery with blood gases nor improvement of recovery after incomplete ischemia or barbiturate anesthesia. The results are interpreted in respect to common concepts of ischemic injury and the treatment of postiehemic resuscitation disease.
Some futuristic possibilities for resuscitation
Griffith, B.P. Department of Surgery, University ofpittsburgh, CRIT. CARE MED., 16(101(198811007- 1011
Pittsburgh, PA, U.S.A.
Future possibilities for resuscitation must take into account our still limited understanding of the reperfusion syndrome. Clinical resuscitation research must incorporate the use of prolonged life-support techniques. These may depend on the use of cardiopulmonary bypass to provide improved reperfusion of vital organs and to permit the time necessary to evaluate and treat the mediators and modifiers of the reperfusion syndrome. It is likely that some patients who require prolonged life support will need replacement organs or, should their brains fail to survive resuscitation, become organ donors. Physicians involved in resuscitation and transplantation must come to grips with the logistic problems of techniques for prolonged resuscitation. Optimal composition of burn resuscitation
fluids
Carvajal, H.F.. Parks, D.H. Division of Pediatric Critical Care, Department Schoolat Houston, Houston, TX 77050, U.S.A. CRIT. CARE MED., 16(71(19881695-700
of Pediatrics,
The University
of Texas Medical
The hemodynamic, renal, and hematologic responses in fluid resuscitation with four different hydrating solutions (lactated Ringers’ and hypertonic salt solutions, with and without albumin) administered in equal quantities were compared in an ovine burn model. Forty-five animals, including a sham group were studied. The burn (40%, flame) was inflicted under anesthesia, but the animals were then studied while in the awakened state. Fluid resuscitation was begun one hour after the burn. While all animals survived the burn and disclosed reasonable hemodynamic stability throughout the experiment, those that received lactated Ringers’ with albumin (LRA) restored their cardiac output to preburn values, by 24 h postinjury demonstrated higher serum albumin and colloid osmotic pressure levels, experienced no elecrolyte or acid-base imbalances, and maintained serum osmolallty within normal limits. In contrast to the other solutions, LRA did not induce edema in unburned tissues, and seemed optimal for burn resuscitation. Correlation of transconjunctival resuscitation in dogs
PO, with cerebral
oxygen
delivery
during
cardiopulmonary
Guerci, A.D.. Thomas, K. Hess, D., Halperin, H.R., Tsitlik, J.E., Wurmb, E., Eitel, D. Cardiology Division, Johns Hopkins HospitaL Baltimore, MD 21205, U.S.A. CRIT. CARE MED., 16(61(19881612-614 The relationship between transconjunctival PO, (PcjO,) and cerebral oxygen delivery (D(dotKl,l was examined in dogs during sinus rhythm and CPR with an inflatable vest. Microsphere-determined cerebral blood flow (CBFl. DfdotlC, and PcjO, readings were normal during sinus rhythm. During CPR, with carotid pressure of 82 f 11125 + 5 (SEM) mm Hg, cerebral perfusion and DfdotQ fell by 53% and 57%, respectively, while PcjO, fell by 87%. After epinephrine administration, carotid pressure increased to 128 f 13/48 + 9 mm Hg, and CBF and D(dot)O, rose to 130% and 115% of pre-arrest levels, respectively, but PcjO, readings remained at 11% of control values. Thus, PcjO, failed to reflect accurately either CBF or MdotK), during CPR. In the presence of epinephrine, PcjO, does not seem to provide an accurate index of the effectiveness of CPR.
Some futuristic possibilities for resuscitation
Griffith, B.P. Department of Surgery, University ofpittsburgh, CRIT. CARE MED., 16(101(198811007- 1011
Pittsburgh, PA, U.S.A.
Future possibilities for resuscitation must take into account our still limited understanding of the reperfusion syndrome. Clinical resuscitation research must incorporate the use of prolonged life-support techniques. These may depend on the use of cardiopulmonary bypass to provide improved reperfusion of vital organs and to permit the time necessary to evaluate and treat the mediators and modifiers of the reperfusion syndrome. It is likely that some patients who require prolonged life support will need replacement organs or, should their brains fail to survive resuscitation, become organ donors. Physicians involved in resuscitation and transplantation must come to grips with the logistic problems of techniques for prolonged resuscitation. Optimal composition of burn resuscitation
fluids
Carvajal, H.F.. Parks, D.H. Division of Pediatric Critical Care, Department Schoolat Houston, Houston, TX 77050, U.S.A. CRIT. CARE MED., 16(71(19881695-700
of Pediatrics,
The University
of Texas Medical
The hemodynamic, renal, and hematologic responses in fluid resuscitation with four different hydrating solutions (lactated Ringers’ and hypertonic salt solutions, with and without albumin) administered in equal quantities were compared in an ovine burn model. Forty-five animals, including a sham group were studied. The burn (40%, flame) was inflicted under anesthesia, but the animals were then studied while in the awakened state. Fluid resuscitation was begun one hour after the burn. While all animals survived the burn and disclosed reasonable hemodynamic stability throughout the experiment, those that received lactated Ringers’ with albumin (LRA) restored their cardiac output to preburn values, by 24 h postinjury demonstrated higher serum albumin and colloid osmotic pressure levels, experienced no elecrolyte or acid-base imbalances, and maintained serum osmolallty within normal limits. In contrast to the other solutions, LRA did not induce edema in unburned tissues, and seemed optimal for burn resuscitation. Correlation of transconjunctival resuscitation in dogs
PO, with cerebral
oxygen
delivery
during
cardiopulmonary
Guerci, A.D.. Thomas, K. Hess, D., Halperin, H.R., Tsitlik, J.E., Wurmb, E., Eitel, D. Cardiology Division, Johns Hopkins HospitaL Baltimore, MD 21205, U.S.A. CRIT. CARE MED., 16(61(19881612-614 The relationship between transconjunctival PO, (PcjO,) and cerebral oxygen delivery (D(dotKl,l was examined in dogs during sinus rhythm and CPR with an inflatable vest. Microsphere-determined cerebral blood flow (CBFl. DfdotlC, and PcjO, readings were normal during sinus rhythm. During CPR, with carotid pressure of 82 f 11125 + 5 (SEM) mm Hg, cerebral perfusion and DfdotQ fell by 53% and 57%, respectively, while PcjO, fell by 87%. After epinephrine administration, carotid pressure increased to 128 f 13/48 + 9 mm Hg, and CBF and D(dot)O, rose to 130% and 115% of pre-arrest levels, respectively, but PcjO, readings remained at 11% of control values. Thus, PcjO, failed to reflect accurately either CBF or MdotK), during CPR. In the presence of epinephrine, PcjO, does not seem to provide an accurate index of the effectiveness of CPR.