BACKGROUND In field situations, patient triage may require early determination of patients progressing to irreversible shock. We investigated the utility of near-infrared spectroscopy (NIRS) in early detection of irreversible hemorrhagic shock. METHODS Twenty instrumented pigs were treated with a protocol involving 35% blood volume hemorrhage, 90 minutes of shock, and stepwise resuscitation w...

Thirty years ago, a publication by Seisjo, entitled ‘Cerebral metabolic rate in hypercarbia—a controversy’ summarized the current state of knowledge related to the influence of hypercapnia (increased pCO2) on cerebral metabolic rate of oxygen consumption (CMRO2) (Siesjo, 1980). Seisjo quoted a number of papers that provided controversial results ranging from reduced, to unchanged, to increased ...

In 1979 in our Journal, Joe Mandl and Richard Motley claimed and demonstrated that the “endpoint of good perfusion is argued to occur when V̇O2 plateaus” despite further interventions (1). Our classic article authors recommended that the continuous calculation of V̇O2 enables the perfusionist to construct an individualized oxygen supply-consumption curve that responds to patient metabolic needs a...

BACKGROUND AND OBJECTIVES Dextran associated with 7.5% sodium chloride has positive hemodynamic effects in the long term control of hemorrhagic shock. The objective of this study was to verify whether the association of dextran with 7.5% chloride solution would be advantageous in the immediate hemodynamic evaluation of controlled hemorrhagic shock in dogs. METHODS This study included 16 dogs ...

Background: Serial blood draws for the assessment of a trauma patient’s hemoglobin (sHgb) and hematocrit (sHct) is standard practice. In the event of multiple casualties this process can be time consuming and lead to the inefficient use of valuable resources. A device that would allow for continuous real-time, non-invasive monitoring of hemoglobin and tissue perfusion would not only improve the...

BACKGROUND Systemic vasodilation using α-receptor blockade has been shown to decrease the incidence of postoperative cardiac arrest following stage 1 palliation (S1P), primarily when utilizing the modified Blalock-Taussig shunt. We studied the effects of a protocol in which milrinone was primarily used to lower systemic vascular resistance (SVR) following S1P using the right ventricular to pulm...

Right ventricular (RV) failure due to chronic pressure overload is a main determinant of outcome in congenital heart disease. Medical management is challenging because not only contractility but also the interventricular relationship is important for increasing cardiac output. This study evaluated the effect of milrinone alone and in combination with epinephrine or dopamine on hemodynamics, ven...

INTRODUCTION Septic shock is characterized by altered tissue perfusion associated with persistent arterial hypotension. Vasopressor therapy is generally required to restore organ perfusion but the optimal mean arterial pressure (MAP) that should be targeted is uncertain. The aim of this study was to assess the effects of increasing MAP using norepinephrine (NE) on hemodynamic and metabolic vari...

Background The change in venous oxygen saturation occurs earlier, and even its reduction is faster than arterial oxygen saturation. The aim of this study was to validate SvO2 and PvO2 for O2 content measurement in children hospitalized w...

Competitive flows syndrome result in severe regional hypoxemia when the deoxygenated flow from the native left ventricle (LV) competes with oxygenated flow from extracorporeal life support (ECLS) pump with potentially severe consequences for the cerebral and coronary circulations. Fast correction of hypoxemia could be obtained by decreasing native LV flow by infusion of a short-acting beta-bloc...