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Physiologic responses to massive intraoperative hemorrhage

K Waxman, W C Shoemaker

    Archives of Surgery (Chicago, Ill. : 1960)
    |April 1, 1982
    PubMed
    Summary

    Massive intraoperative hemorrhage impairs cardiac output and oxygen delivery. Reduced oxygen consumption post-resuscitation may increase mortality risk in surgical patients.

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    Area of Science:

    • Anesthesiology
    • Critical Care Medicine
    • Surgical Physiology

    Background:

    • Massive intraoperative hemorrhage presents significant clinical challenges.
    • Understanding the cardiopulmonary and oxygen transport response is crucial for patient outcomes.

    Observation:

    • In five patients with massive hemorrhage (>1 L/10 min), mean arterial pressure was maintained initially.
    • Systemic and pulmonary vascular resistance increased, while cardiac output and oxygen delivery decreased.
    • Post-hemorrhage control and resuscitation led to increased pressures but continued decreased cardiac output and oxygen delivery.

    Findings:

    • Anesthesia and surgery attenuated normal physiological responses to hemorrhage.
    • Oxygen consumption decreased below pre-hemorrhage levels after resuscitation.
    • Three patients experienced multiple organ failure and died postoperatively.

    Implications:

    • The blunted physiological response to hemorrhage and resuscitation impacts patient survival.
    • Lack of compensatory oxygen consumption increase may be a key factor in postoperative mortality.
    • Further research into managing oxygen transport during massive hemorrhage is warranted.

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