12/16/2023 0 Comments Pulmonary capillary wedge pressureWe then review techniques for determining liquid reactivity based on the classical Frank-Starling and Guyton curves. We will discuss preload indicators first, as this is the initial goal of recovery. Although very basic, we believe that these concepts are of great use to clinicians when dealing with patients with complex hemodynamic manifestations. In this article, we will provide the reader with a practical review of shock resuscitation beyond bolus and fluid responsiveness assessment, discussing the physiological basis of various bedside hemodynamic monitoring tools that can be used to optimize oxygen delivery. In addition, there is a lot of debate about the amount of boluses and the type of fluid that should be used. Because of concerns about the actual bolus, passive leg raising (PLR) has been widely used as a noninvasive method to simulate bolus. Unfortunately, recent literature discussing resuscitation from shock has focused only on preload, especially fluid responsiveness. Hgb-hemoglobin concentration SaO2-arterial oxygen saturation PaO2-arterial oxygen partial pressure. Components that determine oxygen supply (DO2). Therefore, bedside resuscitation of shock relies on the optimization of CO and CaO2 components: cardiac preload, afterload, myocardial contractility, hemoglobin concentration, and arterial oxygen saturation.įigure 1. Oxygen supply is determined by CO and blood oxygen content (CaO2) (Figure 1). Therefore, by its definition, the goal of shock therapy is to increase oxygen supply (DO2) to meet the oxygen demand of machine rest, thereby addressing systemic tissue hypoperfusion. Regardless of the underlying etiology of shock, the development of oxygen debt and tissue hypoperfusion leads to cellular ischemia and damage, as well as underlying multiple organ dysfunction syndrome (MODS) and eventual death. A fourth mechanism is poor perfusion (distributive shock) due to altered blood flow distribution. The underlying mechanism of this physiological emergency is related to cardiac output (CO) due to decreased circulatory volume (hypovolemic shock), obstruction of circulatory blood flow (obstructive shock), or impaired cardiac function (cardiogenic shock). Keywords: shock resuscitation hemodynamic monitoring fluid responsiveness stroke volume venous oxygen saturation blood lactate oxygen supplyĬirculatory shock is defined as insufficient oxygen supply to meet the body's metabolic and oxygen requirements. Within the framework of addressing oxygen deficit and oxygen debt, we discuss venous oxygen saturation (SvO2) and lactate as indicators of shock status and resuscitation endpoints. This review will provide a physiological and practical approach to optimizing oxygen delivery using existing hemodynamic monitoring techniques. Focusing solely on resuscitation of preload and fluid responsiveness, ignoring other key factors to the greatest extent possible, will result in unsatisfactory patient outcomes. During resuscitation from shock, attention should be paid to all components of oxygen delivery, including: cardiac preload, afterload, myocardial contractility, hemoglobin concentration, and arterial oxygen saturation.
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