Volume expansion and flow promotion in shock

Abstract

Summary Volume replacement is the most important step in treating hypovolaemic shock. Blood is needed when the oxygen carrying capacity threatens to fall below a critical level, but has the disadvantage of transmitting virus hepatitis. Anicteric hepatitis is about four times more frequent than the icteric form. Pasteurized plasma protein solution and albumin are free from the risk of transmitting hepatitis virus, and are good volume restorers. Dextran 70 represents the best artificial colloid with additional anti-thrombotic properties. Dextran 40 is indicated in special situations to promote flow. There is no proof that large amounts of Ringer solution are superior for treating hypovolaemic shock in man compared with colloids and electrolytes.

Short chain fatty acids dilate isolated human colonic resistance arteries.

“…4 It has been suggested that microcirculatory failure is the main factor determining whether suture line leakage occurs.' In 1969 Gruber6 reported that canine experiments had shown that oxygen delivery to the tissues was maximal at a packed cell volume reading of 35% (equivalent in humans to a haemoglobin concentration of about 11 g/dl), decreasing sharply on either side of this figure. Likewise, in 1981 Tagart showed' that leaking of low anastomoses in male patients was associated with a mean haemoglobin concentration of 14-6 g/dl while non-leakers had a mean concentration of 12-5 g/dl (p<0-01).…”