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  • 1
    ISSN: 1432-1238
    Keywords: Key words Fluid resuscitation ; Haemodynamic monitoring ; Stroke distance ; Doppler ultrasound ; Hypovolaemic shock ; Severe sepsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To assess the feasibility of constructing left ventricular response curves non-invasively during the fluid resuscitation of critically ill patients in the emergency department (ED) using a portable suprasternal Doppler ultrasound (PSSDU) device.¶Design: Prospective case series.¶Setting: Emergency department, Catholic University of Leuven, Belgium. Patients: Shocked patients in the ED were diagnosed by predefined criteria. Only those thought to require standardised intravenous colloid challenges were observed i. e., sequential boluses of 3.5 ml/kg/10 min titrated against changes in stroke distance (Doppler surrogate for left ventricular stroke volume).¶Results: A total of 50 shocked patients were studied. Stroke distance was measurable in 45 patients. 35 patients were fluid responders in terms of stroke distance. Group mean stroke distance increased during resuscitation (8.6 ± 4.1 cm to 19.5 ± 4.6 cm, P 〈 0.001) and then reached a plateau value (19.6 ± 4.6 cm, P = 0.488). No response to fluid was seen in nine patients of which eight had severe sepsis. Alternative therapeutic approaches increased stroke distance for all of these patients. Evidence for right ventricular dysfunction was found as a cause for fluid non-response in the majority of patients with sepsis.¶Conclusions: Previous experimental work has shown that changes in central blood flow can be derived using the PSSDU device. This clinical feasibility study suggests that the PSSDU can help tailor haemodynamic therapy for an individual patient and give an early indication of treatment failure in the ED.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2013
    Keywords: Arterial blood pressure ; Baroreceptors ; Haemorrhage ; Shivering ; Thermoregulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract 1. Shivering in the barbitone-anaesthetised cat exposed to a lowered ambient temperature was reduced by transient haemorrhagic or drug induced hypotension such that there was a positive correlation between mean arterial blood pressure and the intensity of shivering. 2. Shivering which had been reduced by haemorrhage could be restored by the reinfusion of blood, centripetal stimulation of a buffer nerve or by the intravenous administration of methoxamine. 3. The intensity of shivering was increased by the intravenous injection of methoxamine and by stimulation of a buffer nerve, although the latter response was attenuated by intact buffer nerves. 4. There was a marked variation in the importance of the different buffer nerves in maintaining shivering. 5. Shivering was abolished by deafferentation of the baroreceptors and although it could be restored by electrical stimulation of a buffer nerve methoxamine was then without effect. 6. A prolonged period (90–120 min) of hypotension (50–60 mm Hg) impaired the ability to shiver even after the hypovolaemia and hypotension had been corrected.
    Type of Medium: Electronic Resource
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