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PubMed2004

[Burn shock fluid resuscitation and hemodynamic monitoring].

Successful surgical and intensive care treatment of severely burned patients requires adequate prehospital management and fluid resuscitation adjusted to individual needs of the patient. Burn shock fluid resuscitation is now predominantly performed utilizing crystalloid solutions. Whenever possible, colloid solutions should not be given in the first 24 h after burn injury. The rate of administration of resuscitation fluids should maintain urine outputs between 0.5 ml/kg per h and 1 ml/kg per h and mean arterial pressures of >70 mmHg. Extended hemodynamic monitoring can provide valuable additional information, if burn resuscitation is not proceeding as planned or volume therapy guided by these typical vital signs is not attaining the desired effect. We recommend this in patients with TBSA burns of >30%. Inhalation injuries, pre-existing cardiopulmonary diseases, or TBSA burns of >50% definitely require extended hemodynamic monitoring during burn shock resuscitation. The Swan-Ganz catheter or less invasive transcardiopulmonary indicator dilution methods can be utilized to assess hemodynamic data.

Burn Units↗
PubMed2005

Brain oxygenation and metabolism during repetitive apnea with resuscitation of 21% and 100% oxygen in newborn piglets.

The oxygen distribution in the microcirculation of the piglet's brain and striatal extracellular dopamine were determined during repetitive apnea and resuscitation with 21% or 100% oxygen. Pre-apnea cortical oxygen was 49.5+/-10.4 mm Hg and during each apnea decreased to 8+/-0.9 mm Hg. After ten apneic episodes followed by resuscitation with 21% or 100% oxygen, 7.48+/-1.6% or 2.6+/-0.5% of the tissue volume was below 10 mm Hg, respectively. Extracellular dopamine increased progressively with an increase in the number of apneas with resuscitation of 21% oxygen and at the end of ten apneic episodes it was up to 59,500+/-11,320% of control. There was no increase in extracellular dopamine during apnea resuscitated with 100% oxygen. Repetitive apnea caused progressive increase in fraction of hypoxic brain tissue in newborn. The magnitude of the increase is dependent on whether the animals were resuscitated with room air or 100% oxygen.

Animals↗
PubMed1994

Retrograde coronary blood flow during cardiopulmonary resuscitation in swine: intracoronary Doppler evaluation.

Cardiopulmonary resuscitation-generated coronary perfusion pressure and intracoronary flow velocity was studied with high-fidelity pressure transducers and an intracoronary Doppler catheter in 11 swine undergoing closed-chest manual cardiopulmonary resuscitation. Retrograde coronary blood flow in the mid left anterior descending coronary artery was documented during the compression (systolic) phase of chest compression. Techniques to enhance coronary perfusion pressure gradients, such as increasing the chest compression rate or increasing the force of compression, did not improve antegrade coronary blood flow velocity. Even when the aortic minus right atrial pressure gradient was raised throughout the cardiac cycle of closed-chest manual cardiopulmonary resuscitation, antegrade coronary flow occurred only during the relaxation phase of chest compressions. This study indicates that coronary blood flow during ventricular fibrillation and closed-chest cardiopulmonary resuscitation occurs only during diastole or the release phase of chest compression and supports the use of diastolic coronary perfusion pressure as a reflection of myocardial blood flow during closed-chest manual cardiopulmonary resuscitation.

Animals↗
PubMed1989

Neonatal resuscitation in community hospitals. A regional-based, team-oriented training program coordinated by the tertiary center.

Neonatal resuscitation in community hospitals is problematic because of the lack of on-site personnel with adequate training and experience. Even when efforts are made to transport high-risk mothers to tertiary care centers, the most complex resuscitations must occasionally be performed in all obstetric services. This dilemma can result in increased neonatal morbidity and mortality, and is reflected in the obstetric malpractice crisis. We present an approach to the problem in which a tertiary center actively intervenes to assist regional community hospitals to develop and implement resuscitation team capabilities. Key aspects of the system are training and implementation of hospital shift "Code Pink" teams composed of nonphysician professionals, a regional neonatal resuscitation protocol used by all participants, "mock code" resuscitation drills to maintain skills, and extensive quality assurance both at the local hospital and regional levels.

Clinical Protocols↗
PubMed1985

Effect of inhalation injury on fluid resuscitation requirements after thermal injury.

The presence of inhalation injury has been reported to increase fluid requirements for resuscitation from burn shock after thermal injury. To evaluate the effect of inhalation injury on the magnitude of burn-induced shock, the characteristics of resuscitation of 171 patients with burns covering at least 25 percent of the total body surface area were reviewed. When inhalation injury was suspected, confirmation by xenon-133 scanning, bronchoscopy, or both was obtained. Initial fluid resuscitation was calculated according to the Parkland formula, and titration was initiated to maintain a urine output of 30 to 50 ml/hour. Fifty-one patients had inhalation injuries. Patients with inhalation injuries had a mean fluid requirement of 5.76 ml/kg per percentage of total body surface area burned and a mean sodium requirement of 0.94 mEq/kg per percentage of total body surface area burned to achieve successful resuscitation, compared with a fluid requirement of 3.98 ml/kg per percentage of total body surface area burned and a sodium requirement of 0.68 mEq/kg per percentage of total body surface area burned for the group without inhalation injury (p less than 0.05). These data confirm and quantitate that inhalation injury accompanying thermal trauma increases the magnitude of total body injury and requires increased volumes of fluid and sodium to achieve resuscitation from early burn shock.

Adolescent↗
PubMed1986

Fluid resuscitation in thermally injured children.

The fluid resuscitation requirements and mortality from thermal injury were reviewed in 177 children admitted to the Intermountain Burn Center over a 7 year period. Mean burn size was 27 percent of the total body surface area, whereas the mean full-thickness burn size was 13 percent of total body surface area. Twelve percent of children had associated inhalation injuries. The mean amount of fluid received during burn shock resuscitation was 5.8 +/- 0.25 ml/kg per percentage of total body surface area burned and the mean amount of sodium, 1.06 +/- 0.04 mEq/kg per percentage of total body surface area burned. There was no morbidity due to fluid overload. The presence of inhalation injury did not increase fluid or sodium requirements, but did increase mortality (29 percent versus 7 percent, p less than 0.05). The resuscitative mortality rate for all pediatric patients was 7 percent, the in-hospital mortality rate was 15 percent, and the 50 percent mortality burn correlate for these patients was 64 percent of the total body surface area. Data on children with burns were compared with an unselected, concurrent group of adult burn patients using an analysis of covariance. Fluid and sodium requirements were significantly higher for children, but there was no difference in the length of resuscitation or mortality rate. We conclude that children require much more fluid for resuscitation from burn shock than adults with similar burns. Appropriately aggressive fluid therapy for acute thermal injury in children is essential to achieve an acceptable survival rate in these patients.

Adult↗
PubMed1989

Hypertonic saline-dextran resuscitation of acute canine bile-induced pancreatitis.

In this study, we examined the effects of hypertonic saline-dextran resuscitation (2,400 mOsm of sodium chloride, 6 percent dextran 70) on cardiopulmonary function and extravascular lung water in acute canine pancreatitis. Acute pancreatitis was induced in 21 dogs by injecting 0.5 ml/kg of autologous bile into the pancreatic duct. In 10 dogs, resuscitation was begun with a 4 ml/kg bolus of hypertonic saline-dextran solution; 11 dogs received no bolus. Lactated Ringer's solution was infused in all dogs to maintain mean arterial pressure and cardiac output at baseline values. Pulmonary hypertension accompanied by a significant increase in pulmonary vascular resistance and a decrease in lung blood flow occurred in those dogs resuscitated with lactated Ringer's solution alone. By contrast, dogs in the hypertonic saline-dextran group maintained pulmonary artery pressure and pulmonary vascular resistance at baseline values while nutritive blood flow to the lung decreased progressively. Our data suggest that hypertonic saline-dextran resuscitation effectively restores cardiac function while it significantly reduces fluid requirements, as well as the pulmonary hypertension and pulmonary edema that frequently accompany lactated Ringer's resuscitation of acute pancreatitis.

Acid-Base Equilibrium↗
PubMed1992

Variation in trauma resuscitation and its effect on patient outcome.

There were significant differences in the time taken to resuscitate 257 trauma patients from four internationally recognized trauma centres. The fastest unit completed resuscitation in 15 min while the slowest took 105 min. This variation was not explained by differences in the type of patient dealt with, seniority of the team leader, or the number of personnel in the trauma team. Although there were significant differences between the units with regard to these parameters, they did not account for the resuscitation time variations. The average post-qualification time of the team leader at the fastest unit was 2 years. Although the slowest unit had the smallest trauma team (two people), larger numbers of personnel did not shorten resuscitation times. The time taken to carry out the ABC of the primary survey was significantly correlated with patient's physiological change in the resuscitation room (R = -0.63, P less than 0.0001 with systolic blood pressure; R = -0.68, P less than 0.01 with the revised trauma score). A multiple regression with survival as the dependent variable revealed that this time was also a predictor of the patient's eventual outcome (t = 3.18, P less than 0.005).

Adult↗
PubMed1987

Relocation of nonalbumin proteins after albumin resuscitation.

Prior work showed that albumin (5% A) resuscitation lowered serum globulins and coagulation protein activity levels compared to balanced electrolyte solution (BES) resuscitation. In this experiment, the effect of 1.25% A in BES (A-BES) on serum and lymphatic levels of nonalbumin proteins was studied in 20 splenectomized dogs subjected to reservoir shock and then treated with (a) BES or A-BES, (b) shed blood, and (c) autogenous bank blood. Serum levels of albumin, globulin, and coagulation protein activity were measured preshock, postshock, and daily for 3 days; skin lymph levels were measured on Day 3. Compared to BES, A-BES resuscitation significantly decreased serum globulins and coagulation protein activity of fibrinogen, Factor VIII, and antithrombin III. In contrast, skin lymph globulins and coagulation protein activity levels increased significantly with A-BES compared to BES resuscitation. These data suggest that the serum protein changes seen with albumin-supplemented resuscitation result from extravascular relocation of nonalbumin proteins, possibly, due to an oncotic homeostatic factor.

Animals↗
PubMed1990

Hepatocellular dysfunction occurs early after hemorrhage and persists despite fluid resuscitation.

The liver is a major organ involved in multiple organ failure (MOF) following hemorrhage and trauma. However, it is not known if active hepatocellular membrane transport, measured by in vivo indocyanine green (ICG) clearance, is depressed after hemorrhage and if it persists after resuscitation. To study this, rats were bled to and maintained at a mean BP of 40 mm Hg until 40% of maximum bleedout (MB) volume was returned in the form of Ringer's lactate (RL). The rats were then resuscitated with 2X or 3X the volume of MB with RL and hepatocellular function was determined at various intervals. ICG, two to four doses (0.167-1.667 mg/kg BW), was given intravenously and [ICG] was continuously recorded without the need of blood sampling, using an in vivo hemoreflectometer with computer-assisted data acquisition. Initial velocity of clearance (V0) was calculated from [ICG] vs time (t) according to [ICG] = e (a + bt + ct 2), where eab is V0. Maximal velocity of clearance (Vmax) and Km, a kinetic constant representing the efficiency of the active transport process, were determined from the Lineweaver-Burk plot. The results indicate that Vmax decreased by 66% at MB and remained depressed despite fluid resuscitation. Km, decreased by 58% at MB, returned to prehemorrhage level after 3X RL but was not maintained and it decreased by 60% at 4 hr after resuscitation. This in vivo study demonstrates that active hepatocellular function is significantly depressed early after hemorrhage and persists despite resuscitation with RL and may form the basis of the MOF observed after severe and prolonged hemorrhage.

Animals↗
PubMed1991

A comparison of hypertonic to isotonic fluid in the resuscitation of brain injury and hemorrhagic shock.

We studied the early and late effects of hypertonic resuscitation (HR) on the injured brain using a porcine model of hemorrhagic shock and focal cryogenic brain injury. After shock, swine were randomly assigned to receive a bolus (4 cc/kg) of either Ringers lactate (RL) or 7.5% hypertonic saline in 6% Dextran 70, followed by either RL or hypertonic sodium lactate to restore mean arterial pressure to baseline. All animals were studied for 24 hr after the start of resuscitation. Bolus HR improved cerebral blood flow (CBF) with a lower intracranial pressure (ICP) than RL. Continued hypertonic resuscitation prolonged the period of improved CBF and low ICP. At 24 hr CBF had deteriorated in the region of injury in all study groups and in the uninjured hemisphere in swine receiving RL. These data suggest that rapid resuscitation without increasing ICP for up to 6 hr as seen with hypertonic fluid could conceivably allow adequate time for surgical evacuation of mass lesions and effectively prevent secondary brain injury. This work underscores the importance of prolonged periods of study when evaluating brain resuscitation from traumatic shock.

Animals↗
PubMed1992

Mechanism of the beneficial effects of ATP-MgCl2 following trauma-hemorrhage and resuscitation: downregulation of inflammatory cytokine (TNF, IL-6) release.

Although ATP-MgCl2 improves hepatocellular function in a nonheparinized model of trauma-hemorrhage and crystalloid resuscitation, it remains unknown whether the beneficial effects of this agent are due to downregulation of the release of the inflammatory cytokines, tumor necrosis factor (TNF), and interleukin-6 (IL-6) under those conditions. To study this, rats underwent a 5-cm laparotomy (i.e., trauma induced) and were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of maximum bleedout volume was returned in the form of Ringer's lactate (RL). The animals were then resuscitated with four times the volume of shed blood with RL over 60 min. ATP-MgCl2 (50 mumoles/kg body weight each) or an equivalent volume of normal saline was infused intravenously for 95 min. This infusion was started during the last 15 min of RL resuscitation. Plasma levels of TNF and IL-6 were measured at 1.5 hr after the completion of resuscitation by cytokine-dependent cellular assays. Hepatic blood flow was determined by in vivo indocyanine green clearance (corrected by hepatic extraction ratio for indocyanine green), radioactive microspheres, and [3H]-galactose clearance techniques. The results indicate that the levels of circulating TNF and IL-6 increased significantly in the hemorrhaged-resuscitated animals. ATP-MgCl2 treatment, however, markedly decreased the synthesis and/or release of these cytokines to levels similar to the sham group. The markedly decreased hepatic blood flow (as determined by three different methods) and hepatic extraction ratio for indocyanine green were also restored by ATP-MgCl2 treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1993

Hepatic injury and lipid peroxidation during hemorrhagic shock and resuscitation.

Resuscitation from hemorrhagic shock causes hepatic injury that is similar to the hypoxic injury caused by reperfusion after ischemia. This study was designed to describe the relationship between severe hemorrhagic shock, hepatic injury, and lipid peroxidation. Fasted Sprague-Dawley rats underwent shock (mean arterial pressure 40 +/- 5 mm Hg) for two hours followed by reinfusion of shed blood. Serum ALT levels increased during shock and gradually continued to increase for 24 hours after resuscitation. Lipid peroxidation was assessed by quantification of exhaled ethane and by liver content of thiobarbituric acid reactive substances (TBARS). Expired ethane was increased both during shock and after resuscitation. Hepatic content of TBARS remained at baseline levels during shock, but increased after resuscitation. The results suggest that severe, non-fatal hemorrhagic shock and resuscitation produces a modest hepatic injury that is accompanied by lipid peroxidation in the liver.

Animals↗
PubMedDate not supplied

Newborn resuscitation revisited.

The techniques for assessing and resuscitating newborns at birth have become well established over the last 10 years. Standardization of this procedure lagged far behind the standardization of adult and child resuscitation. In 1987, the American Heart Association and the American Academy of Pediatrics published the combined recommendations of the Working Group on Pediatric Resuscitation and the National Task Force on Neonatal Resuscitation of the Section on Perinatal Pediatrics of the American Academy of Pediatrics. This article summarizes those recommendations and suggests means for nurse-midwives to become certified in neonatal resuscitation.

Asphyxia Neonatorum↗
PubMed1992

Resuscitation. Patient and staff attitudes in the context of cancer.

One hundred oncology and hematology cancer patients from a major teaching hospital and their treating doctors were studied regarding their attitudes toward cardiopulmonary resuscitation (CPR). A descriptive approach was used, incorporating semistructured interviews of patients and medical staff and established questionnaire measures, examining knowledge of and attitudes toward disease and treatment, and projected attitude toward CPR and current psychological functioning. One-third of the patient sample anticipated a time when they would not consent to cardiopulmonary resuscitation. This was significantly associated with good disease prognosis. Patients with a psychiatric past history were also overrespresented. It appears that patient attitude to treatment withdrawal and refusal of CPR is related to disease progression and likely to change over time. This supports a dynamic and evolving model of advance directives rather than any fixed decree. Medical staff reported that they planned to provide half the sample with intensive medical treatment (including Intensive Care support in the event of their cardiac arrest), and 32% were designated for ward-based resuscitation only. Eighteen percent would not be resuscitated. These patients were older, had more treatment side effects, and a poorer quality of life. Those patients with either a psychiatric past history or higher ratings of depressive affect were also overincluded in the doctors' "Do-Not-Resuscitate" (DNR) group. These results suggest that there are other qualitative factors (e.g., current psychological functioning and past psychiatric history) that contribute to DNR decisions beyond the usual disease-based criteria seen in formal DNR protocols.

Adult↗
PubMedDate not supplied

Use of artificial circulation in resuscitation of drowned dogs.

The effectiveness of artificial circulation by the method of Bryukhonenko and his colleagues in the resuscitation of dogs that had died from drowning in fresh- or salt-water was studied. Eight out of ten dogs were revived after freshwater drowning 'death' lasting from 10.5 to 21 min, when a variant of the artificial circulation method, dog donor with a venous pump of the artificial heart, was used. Resuscitated dogs remained alive from 3 to 72 h and died from pulmonary oedema. Artificial circulation appeared to be more effective in resuscitation of dogs drowned in saltwater. Their clinical 'death' lasted up to 31.5 min; clinically signs of pulmonary oedema were not observed in any of them, though some signs of oedema were revealed by histological studies. Of the 42 dogs in this series, all the main functions of the central nervous system were restored in 18 with clinical 'death' for up to 25 min. Resuscitation was performed by one of two methods, either the dog donor plus venous pump of the artificial heart, or the method of Bryukhonenko. The effectiveness of artificial circulation for resuscitation of dogs from drowning was demonstrated.

Animals↗
PubMed1984

Asphyxia, cardiac arrest and resuscitation in rats. I. Short term recovery.

This study was conducted to investigate the degree of insult from asphyxia leading to total body circulatory arrest, as a model for brain resuscitation studies in rats. Of 78 male rats, 68 were anesthetized with halothane in O2/N2O, controlled ventilated, paralyzed with pancuronium and asphyxiated, 5, 7.5, 10, 12.5 and 15 min, respectively. Asphyxiation led to circulatory arrest in 244 +/- 22 s (mean +/- S.E.M.). Resuscitation was successful in 65% within 60 s using controlled ventilation with 100% O2, extrathoracic compressions and epinephrine intravenously. Subsequent intensive care to 6, 12 or 24 h was successful in 50% of resuscitated rats. At 6, 12 and 24 h of recovery, neurologic deficit scores and light microscopic neuropathology scores of the brain after in vivo fixation of the total body with intraventricular paraformaldehyde 3%, revealed a large scatter variability without a clear pattern. Lesions were located mostly in the frontal cortex and hippocampus (footplate) with ischemic neuronal change as the most frequent structural change. Brain cell necrosis was not seen after successful resuscitation. It seems that both scores were influenced by post-insult stress, as indicated by paroxysmal hypertension and motor activity, by complications, such as obstruction of the tracheotomy cannula by abundant sputum production, and by partial sedation with N2O and paralysis with pancuronium. This study indicates the feasibility of an asphyxial insult in rats for use in resuscitation studies of short duration. Although 24 h post-insult recovery is possible, up to 6 h seems most practical, with asphyxia of 7.5-10 min most successful and controllable. Questions are raised about the effects of irritation during the post-insult intensive care on both neurological deficit and neuropathology scores.

Animals↗
PubMed1985

Five years experience of cardiopulmonary resuscitation in a children's hospital.

The emergency call for resuscitation in a children's hospital is reported. Forty-seven resuscitation attempts via the emergency call were made in 43 patients over the past 5 years; 24 out of 43 patients had heart diseases. Cardiac patients were more likely to die within a few days after their resuscitation. The patients, who had previously been in cardiac arrest, lost their lives more often. These results implied that it was very crucial to prevent cardiac arrest especially for cardiac patients in order to save lives. Among the causes of emergency calls, complications with the endotracheal tubes were most common (13) and the airway obstructions followed (11). Summation of two causes, the airway problems, accounted for more than half of the series. Sixteen out of all emergency calls occurred on weekends, and all endotracheal tube troubles broke out during a night shift or on a holiday, that is, the lives of those patients were threatened especially when fewer staff were on duty. Those accidents were embarrassing for us because we believe that all patients must have been under our surveillance all day. Some hospitals have a successful resuscitation rate, organizing a cardiopulmonary resuscitation (CPR) team. However, we obtained better results (about 30%) without a team. It should be borne in mind that it is more desirable to prevent cardiac or respiratory arrests initially rather than save the patients in emergencies.

Child↗