Cardiorespiratory Patterns of Surviving and Nonsurviving Postoperative Patients

Wc, Shoemaker

doi:10.1097/00132586-197302000-00063

Cited by 11 publications

(11 citation statements)

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“…It is well established that high-risk surgical patients who fail to mount an adequate global oxygen delivery will more frequently develop postoperative complications, which are often fatal [12][13][14]. The importance of adequate perioperative global oxygen delivery (DO 2 ) may relate in part to adverse events, which result in excessive oxygen consumption (VO 2 ).…”

Section: Tissue Oxygen Delivery and Consumptionmentioning

confidence: 99%

The use of early intervention to prevent postoperative complications

Jhanji

Pearse

2009

Current Opinion in Critical Care

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Section: Tissue Oxygen Delivery and Consumptionmentioning

confidence: 99%

The use of early intervention to prevent postoperative complications

Jhanji

Pearse

2009

Current Opinion in Critical Care

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“…ionotropes) to improve delivery since it has been reported clinically that improved delivery can frequently be associated with improved oxygen consumption (Shoemaker et al 1993 ;Carton et al 1994). Impaired oxygen transport is frequently the fundamental pathophysiological abnormality in many critical illnesses.…”

Section: Discussionmentioning

confidence: 99%

“…Impaired oxygen transport is frequently the fundamental pathophysiological abnormality in many critical illnesses. In critical illness oxygen supply may not meet the demand and this can lead to functional and structural disturbances of organs and tissues (Shoemaker et al 1993 ;Grant & Nimmo 1995). Reperfusion of a functioning liver is accompanied with an increase in oxygen consumption (Carton et al 1994).…”

Section: Discussionmentioning

confidence: 99%

Measurements of tissue viability in transplantation

Thorniley

Simpkin

Balogun

et al. 1997

Phil. Trans. R. Soc. Lond. B

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SUMMARYNear-infrared spectroscopy has primarily been used in monitoring changes in cerebral haemoglobin oxygenation and haemodynamics. However its use as a method for the assessment of tissue viability following transplantation has recently been explored experimentally in our laboratory.The ability to measure changes in oxygenation and perfusion during harvesting and following transplantation of organs or transfer of free and pedicled flaps is potentially important in reconstructive surgery. We have found that near-infrared spectroscopy is extremely useful in detecting vaso-occlusive events and can accurately and reliably distinguish between arterial, venous or total occlusions. Venous congestion indicated by raised levels of deoxygenated haemoglobin with a concomitant increase in blood volume and the presence and magnitude of reactive hyperaemia are both easily recognizable features by near-infrared spectroscopy. We have shown that near-infrared spectroscopy measurements of venous congestion in kidneys (and other tissues) following prolonged storage correlate with medullary vascular congestion confirmed by angiographical and histological analysis of intrarenal perfusion.Clinically we have shown that flap perfusion can be improved by altering fluid replacement regimes and the addition of ionotropes. Cerebral near-infrared spectroscopy measurements in a liver transplant model showed statistically significant differences within minutes after the anhepatic phase in cerebral perfusion and oxygenation, between animals transplanted with ischaemically damaged livers compared to those isografted with minimally stored livers. Similarly we have found that near-infrared spectroscopy can be used as a monitor to assess the adequacy of fluid or blood replacement in haemorrhagic and hypovolaemic models. We believe that near-infrared spectroscopy provides a sensitive and reliable postoperative method for the assessment of tissue viability following the transfer of free and pedicled flaps and organs.

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“…In the noncardiac surgical population, there are many observational studies that demonstrated an association between reduced cardiac index in the perioperative period and poor postoperative outcome [8][9][10]. Interventional studies where cardiac output and oxygen delivery were measured and artificially manipulated to achieve predefined hemodynamic goals showed a reduction in morbidity and, in some patient groups, improved survival [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%