Download PDF by D. C. Linch (auth.), P. C. Das, C. Th. Smit Sibinga, M. R.: Supportive therapy in haematology

By D. C. Linch (auth.), P. C. Das, C. Th. Smit Sibinga, M. R. Halie (eds.)

ISBN-10: 146129617X

ISBN-13: 9781461296171

ISBN-10: 1461325773

ISBN-13: 9781461325772

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Shoemaker [1] has attempted to provide a number of parameters for determining the prognosis of survival of intensive care patients in various states of shock. He distinguished 35 parameters with a correct prediction score of between 19 and 82% (showing the appendix), but a strikingly high predictive value was achieved when the erythrocyte volume was combined with Oz-transport (Table 1). Red Cell Mass (RCM) introduces not only a volume parameter but also the entire complex of rheological factors related to erythrocyte aggregation and blood viscosity; this could be an explanation for the high prediction score achieved by the first three variables (Table 1).

Figure 1 shows the three possible situations with their consequences for the 02-transport and 02-delivery to the tissues: Situation A with an uniform flow and hematocrit distribution, situation B with an unequal flow and uniform hematocrit distribution, and situation C with an unequal flow and unequal hematocrit distribution [2]. Both an increased and a decreased arteriovenous 02-difference can be a sign of maldistribution, diminishing the real value of the clinical parameters, 02-consumption (V0 2) and 02-extraction (02 EX), which are derived, among other things, from the arterial-mixed venous 02-gradient.

7. Kaplan JA (ed): In: Cardiac Anesthesia. Grune & Stratton, New York, 1979: 99-100. 8. Kaplan JA: Vasodilators or inotripic agents in the management of intraoperative cardiac failure. 7th World Congress of Anaesthesiologists, Hamburg, 1980. 9. Messmer K: Hemodilution. Surg Clin N Amer, 1975; 55: 659-78. 10. Wood JH, Fleischer AS: Observations during hyper- 11. 12. 13. 14. volemic hemodilution of patients with acute focal cerebral ischemia. Preliminary Communications. JAMA, 1982; 248: 2999-3005.

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Supportive therapy in haematology by D. C. Linch (auth.), P. C. Das, C. Th. Smit Sibinga, M. R. Halie (eds.)


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